Letter to the Editor: Where is the lateral femoral wall?

Abstract

Dear Editor: With great interest we read the article by Haq et al. regarding the comparison of different fixations for intertrochanteric fractures with a compromised lateral femoral wall [1]. It is the intact lateral femoral wall that can support the femoral head–neck fragment and fixation and also control collapse of the fracture [2–4]. According to Haq et al., the lateral femoral wall is the projection of the femoral neck in the lateral cortex of the proximal femur [1] (Fig. 1a). It seems to be easier to confirm the exact area of the lateral femoral wall on radiographs. We have some different views on the area of the lateral femoral wall. Initially, the lateral femoral wall was described at the drilling site of femoral head–neck fixation [2]. Then it was defined as the lateral cortex proximal to the vastus ridge [4]. The standard site of the femoral head–neck fixation is commonly above the plane of the lesser trochanter. Therefore, in our opinion, the lateral femoral wall is defined as the lateral cortex proximal to the vastus ridge and distal to the plane of the lesser trochanter (Fig. 1b). The area can provide a buttress for the femoral head–neck fragment and fixation. “The lateral femoral wall” drawn according to the method of Haq et al. on radiographs includes part of the lateral greater trochanteric wall [5], the lateral femoral wall and the lateral proximal cortex below the plane of the lesser trochanter. The lateral greater trochanteric wall is cancellous, rather than cortical bone, without a buttress for the femoral head–neck fragment and fixation. The lateral proximal cortex below the plane of the lesser trochanter is not really the drilling site of the femoral head–neck fixation. When the lateral femoral wall is reconstructed using the trochanteric stabilising plate (TSP), that cortex below the plane of the lesser trochanter is not reconstructed [6]. The effect of that cortex should be appropriate for subtrochanteric fractures in a narrow sense (≈5 cm distal from the lesser trochanter), rather than intertrochanteric fractures. There is a distinction of biomechan i ca l mechan i sm and s t ab i l i t y be tween suntrochanteric and intertrochanteric fractures. Thus, the concept of the lateral femoral wall has been introduced for intertrochanteric fractures. At the same time, the vastus ridge is the watershed of cortical and cancellous bone.