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The third trochanter (TT) is a proximal femoral accessory tubercle at the upper border of the gluteal tuberosity that is unusually encountered on the posterior aspect. However, detailed knowledge about the TT remains limited. For this reason, TT was investigated in all its aspects. To give an overview about the TT, a review was conducted in databases until November 2021. Out of 4981 articles, only 53 articles could be included, most of which were studies conducted on dry femurs. The TT can be a result of the developmental process of gluteus maximus due to posture and bipedal locomotor activity. Another explanation of the formation of TT is the inactivation, deficiency, or mutation of specific genes that cause alterations in the proximal femoral end. The current review leads to the assumption that TT, considered for all mammalians, can be an evolutionary adaptation and may be a result of altered muscle activity, increased mechanical force, and reduced stress on the femoral shaft. Therefore, TT should be used in genomic studies related to the evolution of mammalians. An improvement in study design, the scale of the study, methodology, and the selection of mammalian species may permit more comprehensive analysis and reduce study heterogeneity.

Is the third trochanter of the femur a developmental anomaly, a functional marker, or an evolutionary adaptation?