Examination of the Pronator Quadratus Muscle during Hardware Removal Procedures after Volar Plating for Distal Radius Fractures

Nho, Jae‐Hwi; Gong, Hyun Sik; Song, Cheol Ho; Wi, Seung Myung; Lee, Young Ho; Baek, Goo Hyun

doi:10.4055/cios.2014.6.3.267

Cited by 24 publications

(15 citation statements)

References 25 publications

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“…Since we have excluded patients with anterior rotatory muscle injury before the study, we do not believe that primary injury is a common cause of postoperative loss of muscle function. Nho [15] also confirmed that the PQ muscle was atrophic during the removal of internal fixation, and that the muscle width was independent of the final clinical functional outcome, suggesting that the PQ muscle may be functionally lost after suture. Because pronator teres is the main muscle of forearm pronation [17], the loss of pronator teres can be compensated by pronator teres, so that forearm rotation can be preserved.…”

Section: Discussionmentioning

confidence: 67%

Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius

fang

Lin

Liu

et al. 2020

Preprint

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Background: For fracture of the distal radius, open reduction and internal fixation are often used for treatment. In the process of open reduction and internal fixation, it is often necessary to open the pronator quadratus muscle to achieve sufficient exposure. So it's important to know if it's necessary to suture the pronator quadratus muscle. Purpose: To see if suturing the pronator quadratus during the treatment of fracture of the distal radius would improve limb function. Methods: 126 patients were selected for our study. These patients had open reduction and internal fixation.During the procedure, the pronator quadratus is cut open to allow the plate to be placed.Before the surgery was completed, the pronator quadratus muscles of these patients were stitched together. After the fracture healed, the patients underwent surgery to remove the internal fixation. These patients received wrist function scores prior to removal of internal fixation.The healing of the pronator quadratus was investigated during surgery. These patients were grouped according to the healing of the pronator quadratus. Functional scores were compared between the two groups Results: 23 patients were considered to have muscle healing during surgery. However, in these patients, the PQ muscles were obviously atrophic, with scar hyperplasia and fibrosis.The muscle fibers were loose and thin, and the number was reduced. At the same time, the remaining muscle fibers have different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. According to the intraoperative situation,23 patients were included in group A and 103 patients were included in group B. There were no statistically significant differences in age and fracture type between group A and group B.At the same time, there were no statistically significant differences in isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups.Conclusions: this study demonstrates that whether the PQ muscle healing or not does not affect the outcomes of volar plating for distal radius fractures in terms of isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores.

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Section: Discussionmentioning

confidence: 67%

Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius

fang

Lin

Liu

et al. 2020

Preprint

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“…Nanno et al observed that the transverse gliding area of the FPL at the volar distal radius rim could be covered by the PQ suture to protect the FPL from attrition on the plate. Then, suturing the PQ may act as a protective sleeve to protect the flexor tendons on the distal part of the plate, even if the suture is partial or loose . This suture is considered difficult because of a thin muscle, which is often torn by the fracture.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating

Walch

Erhard

Vogels

et al. 2019

J of Ultrasound Medicine

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The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015. The PQ was repaired in all patients. A clinical, ultrasound, and perioperative evaluation of the flexor tendon was performed by this same surgeon. There was no flexor tendon rupture or tenosynovitis. There were no type A cases, which are characterized by contact between the plate and the FPL, and mostly type C cases, which are characterized by no contact between the plate and the FPL on US imaging. The suture of the PQ was sustainable over time when we removed the plate. Pronator quadratus repair is one of the ways to prevent flexor tendon rupture after volar plating. The outward-running suture is an effective technique for repairing the PQ. Ultrasound may be helpful during follow-up to detect asymptomatic flexor tendon irritation.

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“…For example, electromyographical (EMG) analysis of muscle activation patterns upon DRUJ loading and increased knowledge on the necessity of the deep head of PQ as a primary stabilizer for the DRUJ. 13,14 Despite this, it still remains unclear whether or not repairing of the PQ after volar plating of DRFs has any positive effect on clinical outcome. 11,14,15 This is a functionally important question that we hope to be able to address with the torque meter eventually.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Despite this, it still remains unclear whether or not repairing of the PQ after volar plating of DRFs has any positive effect on clinical outcome. 11,14,15 This is a functionally important question that we hope to be able to address with the torque meter eventually. Also, effects of isometric and isotonic muscular activation on stability can be addressed to further strengthen the current proposed test design.…”

Section: Discussionmentioning

confidence: 99%

A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

et al. 2018

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Background Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination. Methods A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries. Results A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients (n = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side). Conclusion Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque. Level of Evidence This is a Level II study.

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Examination of the Pronator Quadratus Muscle during Hardware Removal Procedures after Volar Plating for Distal Radius Fractures

Cited by 24 publications

References 25 publications

Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius

Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius

Ultrasound Evaluation of the Protector Role of the Pronator Quadratus Suture in Volar Plating

A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

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