The effect of pronator quadratus repair on outcome after volar plating of distal radius fracture

Abstract

Background: The incidence of fracture distal end of the radius is increasing with increasing life expectancy along with osteoporosis. Open reduction and volar plating has the biomechanical advantage of load bearing and buttressing function. Proposed advantages of pronator quadratus repair during volar plating of distal radius are the restoration of pronation strength, protection of flexor tendons from attrition or rupture and stabilization of the distal radio-ulnar joint whereas a tight repair may lead to the risk of ischemic contracture resulting into limited wrist pronation and supination. We aim to study the effects of pronator quadratus repair during volar plate fixation of distal radius fracture. Methods: Traumatic extra-articular isolated closed, Gustilo grade I and II fracture of distal end radius with/without fracture ulna of adults presenting within 1 week were subjected to either repair or no repair group of pronator quadratus during volar plating of distal radius. They were operated by the same standard approach, subjected to same physiotherapy protocol and followed up regularly for at least one year post-operatively for outcome assessment. Result: The cohort of patients in non-repair group (n = 19, mean age: 27.68 ± 8.38 years) and repair group (n = 13, mean age: 32.00 ± 15.58 years) have similar demographic and fracture characteristics. At 1 year, they had no significant difference in overall pain by visual analogue score (p = 0.989), functional outcome by disabilities of arm, shoulder and hand score (p = 0.178) and wrist range of motion (p > 0.05). Conclusion: We conclude that there is no added advantage of pronator quadratus muscle repair during volar plating of distal radius. The functional outcome, overall pain and range of motion of wrist were not significantly different between them.