Is pronator quadratus repair necessary to improve outcomes after volar plate fixation of distal radius fractures? A systematic review and meta-analysis

Abstract

PurposeThis systematic review and meta-analysis was conducted to compare functional outcomes with or without pronator quadratus (PQ) repair after volar plate fixation of distal radius fractures. MethodsAn electronic search was conducted for PubMed, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google Scholar databases up to 15th January 2020. Both retrospective case-control and randomised control trials (RCTs) were included. ResultsA total of 6 studies met the inclusion criteria. 4 were RCTs and 2 were retrospective studies. The primary outcome was the difference in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores between the two groups. On analysis of 203 patients with PQ repair and 180 patients with no repair, our results indicated no statistical significant difference in DASH scores between the two groups (SMD: 0.43, 95% CI: −0.12 to 0.98, I2=85%, p=0.12). Also, meta-analysis did not demonstrate any difference in grip strength (SMD: −0.10, 95% CI: −0.53 to 0.33, I2=64%, p=0.64) and pronation strength (SMD: −0.02, 95% CI: −0.82 to 0.78, I2=82%, p=0.96) with or without PQ repair. The pooled analysis did not demonstrate any benefit of PQ repair in improving postoperative ROM. ConclusionOur results indicate that repair of PQ muscle may not be necessary after volar plate fixation of distal radius fractures. Further large scale RCTs shall validate our conclusions. Level of evidenceII, systematic review and meta-analysis.