The subscapularis footprint: an anatomic study of the subscapularis tendon insertion.

PURPOSE: Arthroscopic repair of the subscapularis tendon has become more prevalent in recent years. Tears of the subscapularis insertion can be measured arthroscopically when the size of the average subscapularis tendon insertion is known. This anatomic study was performed to measure the dimensions and describe the anatomy of the subscapularis footprint. METHODS: A total of 6 male and 6 female shoulders were dissected down to the insertion of the subscapularis tendon. The insertion was demarcated, the tendon was detached, and the dimensions of the insertion site were measured. RESULTS: The footprint is the insertion of the subscapularis tendon onto the lesser tubercle. The shape of the footprint was characterized as resembling a human ear. The insertion is broad proximally and tapered distally and has a straight medial border that is almost parallel to the longitudinal axis of the humerus. The total average cephalocaudal height of the footprint was 25.8 mm (+/-3.2 mm). The total average width was 18.1 mm (+/-1.6 mm). Average male cephalocaudal height was 26.7 mm (range, 22 to 32 mm), and width was 18.3 mm (range, 16 to 21 mm). Average female cephalocaudal height was 24.8 mm (range, 22 to 29 mm), and width was 17.8 mm (range, 15 to 19 mm). Although the male footprint was slightly larger than the female footprint, differences were not statistically significant (P = .18 and .31 for height and width, respectively). CONCLUSIONS: An anatomic study was performed to determine the size of the footprint of the subscapularis tendon. We found that the average cephalocaudal height of the footprint was 25.8 mm, and the average width was 18.1 mm. CLINICAL RELEVANCE: Subscapularis tears are now more frequently addressed arthroscopically. This anatomic study was performed to characterize the anatomy of the subscapularis footprint so that the surgeon can achieve a more anatomic repair.

Treatment of distal radius malunions with an intramedullary nail.

Malunion of the distal radius are the most common complications of distal radius fractures. Increased angulation of the distal radius can result in altered load concentrations on the wrist, decreased range of motion, decreased grip strength, and residual incongruence of the radiocarpal and distal radioulnar joints. Multiple options exist for fixation of corrective osteotomies of the distal radius, including intramedullary nails. The use of an intramedullary nail provides the benefits of a percutaneous insertion technique, low-profile implant, load-sharing design, and fixed-angle locking screws in the distal fragment. We describe an innovative technique for intramedullary fixation for corrective osteotomies of extraarticular distal radius malunions.