Distal radius fractures are the most common type of upper extremity fractures, and their incidence is increasing. There has been a rise in the surgical treatment of distal radius fractures, primarily with volar locking plate fixation. Although this procedure is commonly done among orthopaedic surgeons, the role of pronator quadratus repair after fixation remains controversial. The pronator quadratus serves as a secondary forearm pronator and a dynamic stabilizer of the distal radioulnar joint. Aside from a functional role, repair of the pronator quadratus has been proposed to serve as a biologic barrier between the volar locking plate and the flexor tendons to minimize tendon irritation. In this narrative review, we discuss the current treatment trends, the surgical approach for volar locking plate treatment of distal radius fractures, and the anatomy and function of the pronator quadratus. We discuss the case for and against the repair of the pronator quadratus, both for function and prevention of flexor tendon irritation and rupture. The preponderance of high-level evidence demonstrates no benefit to pronator quadratus repair for pain relief or function. The current evidence does not conclusively support or refute pronator quadratus repair as a biologic barrier from the flexor tendons.
Distal radius fractures are the most common fractures of the upper extremity, with an incidence of 16.2 per 10,000 people. These fractures are bimodally distributed across age groups and account for approximately 25% of fractures in pediatric patients and 18% of fractures in geriatric patients. 1 A recent literature synthesis of the epidemiology of distal radius fractures suggests that the incidence of these fractures is increasing worldwide. 2 These injuries are associated with notable morbidity to the patient and economic burden to the healthcare system. [3][4][5] Although most distal radius fractures may be treated nonoperatively, there are a number of surgical indications. These include open fractures, partial articular shear fractures and fracture-dislocations, die-punch fractures, concomitant fractures, unacceptable fracture parameters in a young or active elderly patient, subsequent loss of reduction after initial closed reduction, or anticipated loss of reduction based on fracture characteristics. 6 Surgical