No effect on functional outcome after repair of pronator quadratus in volar plating of distal radial fractures: a randomized clinical trial

Abstract

Aims The aim of this study was to investigate the difference in functional outcome after repair and non-repair of the pronator quadratus muscle in patients undergoing surgical treatment for a distal radial fracture with volar plating. Patients and Methods A total of 72 patients with a distal radial fracture were included in this randomized clinical trial. They were allocated to have the pronator quadratus muscle repaired or not, after volar locked plating of a distal radial fracture. The patients, the assessor, the primary investigator, and the statistician were blinded to the allocation. Randomization was irreversibly performed using a web application that guaranteed a secure and tamper-free assignment. The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) after 12 months. Secondary outcomes included the Disabilities of the Arm, Shoulder and Hand (DASH) score, pronation strength, grip strength, the range of pronation and supination, complications, and the operating time. Results Of the 72 patients, 63 (87.5%) completed follow-up for the primary outcome measure: 31 (86.1%) from the non-repair group and 32 (88.9%) from the repair group. At the 12-month follow-up, the mean difference in PRWE of 5.47 (95% confidence interval (CI) -4.02 to 14.96) between the repair (mean 18.38 (95% CI 10.34 to 26.41)) and non-repair group (mean 12.90 (95% CI 7.55 to 18.25)) was not statistically significant (p = 0.253). There was a statistically significant difference between pronation strength, favouring non-repair. We found no difference in the other secondary outcomes. Conclusion We found that repairing pronator quadratus made no difference to the clinical outcome, 12 months after volar plating of a distal radial fracture. We conclude that there is no functional advantage in repairing this muscle under these circumstances and advise against it. Cite this article: Bone Joint J 2019;101-B:1498–1505

A systematic review and meta-analysis of the pronator quadratus repair following volar plating of distal radius fractures

“…Regarding pronation strength, two studies showed that the pronation strength in the group without PQ repair decreased significantly only in the patients with AO/ OTA type B fractures but not in those with AO/OTA type C fractures [22,25]. One study included patients with AO/OTA type A2, A3, and C1 fractures [18], while another study included patients with AO/OTA type A2, A3, C1-3 fractures [10]. Having better repair quality with preoperatively intact and nicely prepared PQ flaps seems logical.…”

“…Although the durability of PQ repair has been supported [5], ensuring good-quality repair, especially in comminuted DRFs with frayed PQ muscles, is sometimes difficult. Two RCTs routinely checked the length or retraction of the PQ in ultrasonography examinations [10,18]. In our included studies, patients in the group without PQ repair who had more metaphyseal displaced and complex fracture patterns had better pronation strengths (Fig.…”

“…Between-reviewer discrepancies were resolved through discussions under the supervision of the corresponding author. We tried to contact the primary authors of all the included studies; however, only the authors of three studies responded and provided complete original data sheets [7,8,10].…”

“…An additional prospective randomized controlled study revealed that PQ repair might reduce pain in 3 months postoperatively [9]. The most recently published randomized controlled trial concluded that PQ repair showed no significant improvement in clinical outcome 1 year after surgery [10].…”

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

“…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. Many studies also believe that suture of pronator anterior muscle may not give patients better function and mobility [18][19][20].…”