The Effects of Pronator Quadratus Repair on Outcomes After Volar Plating of Distal Radius Fractures

Hershman, Stuart H.; Immerman, Igor; Bechtel, Christopher; Lekic, Nikola; Paksima, Nader; Egol, Kenneth A.

doi:10.1097/bot.0b013e3182539333

Cited by 86 publications

(81 citation statements)

References 15 publications

(10 reference statements)

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“…The results of this study support the previous findings that dissection of the PQ muscle has minimal clinical impact on forearm rotation function 4,13,14). In a previous study that used isokinetic testing, Huh et al4) found that after loose repair of the PQ muscle after volar plating, both pronation and supination strengths were lower in the operated sides than in the normal sides at 6 months postoperatively; but at 1 year postoperatively, pronation strength was not significantly different and the decrease in pronation strength did not affect clinical outcomes.…”

Section: Discussionsupporting

confidence: 89%

“…On the contrary, Swigart et al9) found that there was no significant difference between the extent of PQ injury observed during the fracture fixation and clinical outcomes that included wrist motion and grip strength. In addition, studies reported outcomes that were not significantly different between injured and uninjured forearms or between PQ repair in patients with a DRF treated with volar plating 4,13,14). However, none of the studies have assessed the correlation between the actual anatomical healing status of PQ after volar plating and clinical outcomes.…”

mentioning

confidence: 99%

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

et al. 2014

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BackgroundIt is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes.MethodsWe examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length.ResultsThe average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores.ConclusionsThis study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

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Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

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

et al. 2014

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“…Concerning the latter study, results are not ambiguous. Hershman et al showed in contrast to the recommendation of Brown and Lifchez that there is no advantage in repairing the pronator quadratus during palmar plating of distal radius fractures [21,22]. No difference could be recognized concerning range of motion, grip strength or DASH and VAS score 1 year postoperatively if the pronator quadratus was refixed or not after palmar plating of the distal radius [23].…”

Section: Discussionmentioning

confidence: 98%

Anatomical fit of seven different palmar distal radius plates

Oppermann

Wacker

Stein

et al. 2014

Arch Orthop Trauma Surg

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Although there was no complete congruency between the plates and the radial cortex, all distal palmar radius plates investigated in this study presented a reasonable anatomical shape. The Synthes VA-LCP distal two-column-radius plate palmar showed the best anatomical fit. A low profile and optimized anatomical precontouring minimizes irritation of the surrounding soft tissues and should be considered with plate design and implant choice.

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“…A recent clinical study examined the potential hazards of failing to repair the PQ after open volar approach. 17 This study did not find a clear outcome difference between patients in whom repair was attempted and patients in whom it was not. However, this is not the question examined by this biomechanical study, in which PQ excursion is limited.…”

mentioning

confidence: 43%

Simulation of Altered Excursion of the Pronator Quadratus

Feeney

Wentorf²,

Putnam

2014

Jnl Wrist Surg

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The purpose of our study was to determine whether restricted excursion of the PQ muscle alone could affect forearm rotation. Materials and Methods Specimen PreparationEight adult, fresh-frozen, unmatched upper extremities were amputated at the mid-humerus. All of the specimens used appeared free from any prior trauma. The skin, subcutaneous tissue, and forearm flexor and extensor muscles were excised to the level of the wrist joint. The biceps tendon, elbow Keywords► pronator quadratus ► distal radius fractures ► volar approach to ORIF of distal radius ► fracture ► complications of distal radius fracture ► forearm rotation AbstractBackground Loss of forearm rotation is frequently seen after healing of distal radius fractures. Questions/Purposes Our purpose was to determine whether restricted excursion of the pronator quadratus muscle can affect forearm rotation. Methods We evaluated the relationship between pronator quadratus excursion and forearm rotation in a cadaveric model. Eight adult fresh-frozen above-elbow specimens were attached to a mounting device that permitted free rotation of the forearm around its ulnar axis. Forearm rotation was measured with a protractor while alternating pronation and supination loads were applied. Measurements were repeated after restricting the excursion of pronator quadratus by 10, 20, and 30% of its initial length. Results There was a mean 15°loss of supination for each 10% reduction in pronator excursion. There was no significant effect on pronation. Conclusions We conclude that, independent of any bone deformity or nearby joint stiffness, posttraumatic scarring of this muscle may result in a loss of supination.

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The Effects of Pronator Quadratus Repair on Outcomes After Volar Plating of Distal Radius Fractures

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 86 publications

References 15 publications

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

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

Anatomical fit of seven different palmar distal radius plates

Simulation of Altered Excursion of the Pronator Quadratus

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