Clinical Anatomical Study on Reconstruction of Femoral Calcar in Intertrochanteric Fractures

Objective:To investigate the anatomical features of the area around the femoral calcar,as well as the methods of the femoral calcar reconstruction.Methods:A total of 15 adult cadavers were harvested.Dynamic hip screw(DHS) or Gamma nail was used to simulate the clinical operation of fixing the intertrochanteric fractures.The 3-D anatomical data around the femoral calcar and the relative position between the entrance point of the lag screw and the lesser trochanter were investigated.The pulling screw was used to fix the lesser trochanter,and the point of entrance,angle,direction and length were measured.Results: There was a loose connective tissue space between vastus lateralis muscle,rectus femoris and vastus intermedius muscle around the area of femoral calcar,but at the posterior part of the area,there is a lot of muscles attached to the bone.The distance between the lesser trochanter and the lateral side around the femur was(5.45±0.15) cm.It was easy to replace the lesser trochanter through the loose connective tissue.The center of the lesser trochanter and the entrance point of the lag screw were almost at the same level.The lesser trochanter located at the posteromedial side,so it was easy to fix the lesser chocanter in front of the DHS plate with a pulling screw.The distance between the posterior side of the Gamma nail and the posterior bony cortex was about(18.9±1.8) mm,so there was enough space to insert a pulling screw to fix the lesser trochanter.Conclusions: It is easy to replace the lesser trochanter through the anterior loose connective tissue space of the femur.Through the anteromedial side of the DHS plate and the posteromedial side of the Gamma nail,it is easy and less invasive to fix the lesser trochanter with a pulling screw.All these data can serve as references for the treatment of the intertrochanteric fractures.