The subtrochanteric region of the femur encompasses the proximal 5 cm of the femoral shaft below the lesser trochanter. It is a zone of high mechanical stress where the cortex is thick medially (the calcar) and thinner laterally, making it susceptible to specific fracture patterns. The iliopsoas, abductors, and external rotators create characteristic deforming forces on fractures in this region.
Subtrochanteric fractures are among the most technically demanding femoral fractures to fix, due to the high deforming muscle forces that produce flexion, abduction, and external rotation of the proximal fragment. They are classified by the Seinsheimer system. Bisphosphonate-associated atypical femoral fractures characteristically occur in the subtrochanteric region with a transverse fracture pattern and periosteal thickening on the lateral cortex. Intramedullary nailing with proximal interlocking is the preferred fixation.
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