Does pronator quadratus repair affect functional outcome following volar plate fixation of distal radius fractures? A systematic review and meta-analysis

Ying, Liwei; Cai, Guoping; Zhu, Zuqing; Yu, Guoliang; Su, Yongwei; Luo, Hua

doi:10.3389/fmed.2023.992493

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…However, they did not assess the contribution of the two PQ heads separately. The systematic review and metaanalysis carried out by Ying et al (2023) showed that PQ repair may increase grip strength and pronation function in the short-term. However, owing to the limited number of studies included in that review (n ¼ 7), more data from larger studies are needed to verify those conclusions.…”

Section: Discussionmentioning

confidence: 99%

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Is pronator quadratus muscle repair required after anterior plate fixation for distal radial fractures? A prospective randomized comparative study

Lamas,

Arenas,

Almenara

et al. 2023

J Hand Surg Eur Vol

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In this prospective, randomized comparative study in patients with distal radial fractures, we aimed to determine whether surgical repair of the superficial head after anterior locking plate fixation of the radius improves clinical or functional outcomes or both, and distal radioulnar joint stability. One hundred patients were randomized to undergo distal radial fixation with or without repair of the superficial head. Twenty-one patients were lost to follow-up, leaving a final sample of 79 patients. No differences were observed between the groups in functional scores or complication after operation. Surgical repair of the superficial head of the pronator quadratus muscle after osteosynthesis with an anterior locking plate for distal radial fractures does not appear to substantially contribute to preserving distal radioulnar joint stability or improving the consolidation process. Level of evidence: II

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Section: Discussionmentioning

confidence: 99%

“…However, they did not assess the contribution of the two PQ heads separately. The systematic review and meta-analysis carried out by Ying et al. (2023) showed that PQ repair may increase grip strength and pronation function in the short-term.…”

Section: Discussionmentioning

confidence: 99%

Is pronator quadratus muscle repair required after anterior plate fixation for distal radial fractures? A prospective randomized comparative study

Lamas,

Arenas,

Almenara

et al. 2023

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…Distal radial fracture is the conjuncture of cancellous and cortical bone, which is a fracture within 3 cm of the distal radius articular surface [ 1 – 3 ]. The incidence of osteoporosis, which easily leads to high loss and fracture fragment comminution after injury, accounts for about 17% of emergency orthopedic patients [ 4 ], and the data will improve as our population ages.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

Huang,

Wu,

Hamiti

et al. 2023

J Orthop Surg Res

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Objective The traditional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, intraoperative repair of the PQ muscle often fails due to tissue injury and unstable muscle repair. This study compared the outcomes of different methods of sparing the PQ muscle combined with the volar plate in treating distal radius fractures. Methods A total of 95 patients with distal radius fractures sparing the PQ muscle were enrolled with the brachioradialis (BR) splitting approach (group A, 33 people), the volar plating insertion PQ muscle approach (group B, 35 people) and traditional Henry approach without sparing PQ muscle (group C, 27 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the three groups. The visual analog scale (VAS) of postoperative wrist pain was compared between three groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy. Results A total of 95 patients with distal radius fractures were followed up for more than one year after surgery. All fractures obtained good union, with no vascular injury, nerve injury or wound infection. Outcomes at three days, one month and three months all showed no significant differences in postoperative imaging indexes among three groups and no significant differences in various indexes among three groups during the same period. The mean operative time in group C was significantly lower than that in groups A and B. There was significant difference in the mean operation time between group A and group B. The amount of mean operative blood loss or mean bone union time in groups A and B was significantly lower than those in group C. No significant difference was shown in mean operative blood loss or mean bone union time between group A and group B. No significant differences in limb function scores, VAS scores and the mean range of motion existed among three groups at the 12-month postoperative follow-up. However, outcomes assessed one week, one month and three months after surgery demonstrated significant differences in the VAS scores and the mean range of motion among three groups, and the group B had lower VAS score and greater the mean range of motion. According to Dienst score, the excellent rate in groups A, B and C was 91.0% (30/33), 94.2% (33/35) and 85.2% (23/27), respectively, at 12 months after surgery. Tendon irritation occurred in 2 cases and joint stiffness in 1 case in group A. In group B, there were 2 cases traumatic arthritis and 2 cases delayed carpal tunnel syndrome and 1 case tendon irritation. In group C, tendon irritation and delayed carpal tunnel syndrome occurred, respectively, in 3 cases. Conclusion Our results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. The volar plating insertion PQ muscle approach could reduce early postoperative pain, promote early activity and return to normal life, while the BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. At 12 months of follow-up, no significant advantage was seen in sparing the PQ muscle. Therefore, surgeons should be aware of their individual characteristics and choose patients carefully.

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Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

Huang¹,

Liu²,

Xue

et al. 2023

Preprint

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Background The conventional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, releasing PQ muscle could cause loss of function and a host of complications.Aim This study compared the outcomes of different methods of sparing the PQ muscle combined with volar plate in the treatment of distal radius fractures.Methods A total of 68 patients with distal radius fractures were enrolled with either the brachioradialis (BR) splitting approach (Group A,33 people) or through the tunnel behind the PQ muscle approach (Group B,35 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the two groups. The visual analog scale (VAS) of postoperative wrist pain was compared between the two groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy.Results A total of 68 patients with distal radius fractures were followed up for more than 1 year after surgery. All fractures obtained good union, with no vascular injury, nerve injury, or wound infection. There was no significant difference in the baseline characteristics of both groups. Outcomes at 3 days,1 month,and 3 months all showed no significant differences in postoperative imaging indexes between the two groups. There were significant differences in the mean operative time between the two groups. Nevertheless, no significant differences were shown in mean operative blood loss and mean bone union time between the two groups. There was no significant difference in the results of complications between the two groups. No significant differences in limb function scores, VAS scores and the mean range of motion existed the two groups at the 12-month postoperative follow-up. However, outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the VAS scores and the mean range of motion between the two groups.Conclusion Our results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. Placing the plate under the quadratus muscle could reduce early postoperative pain, promote early activity, and returned to normal life. The BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. Therefore, surgeons should be aware of their individual characteristics and chose patients carefully.

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Does pronator quadratus repair affect functional outcome following volar plate fixation of distal radius fractures? A systematic review and meta-analysis

Cited by 3 publications

References 30 publications

Is pronator quadratus muscle repair required after anterior plate fixation for distal radial fractures? A prospective randomized comparative study

Is pronator quadratus muscle repair required after anterior plate fixation for distal radial fractures? A prospective randomized comparative study

Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

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