Pronator Quadratus Research Articles

Can the results of a randomized controlled trial change the treatment preferences of orthopaedic surgeons?

AimsThe aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized contolled trial (RCT) and to study patterns of change between subspecialties and nationalities.MethodsTwo questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year.ResultsOf the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, six of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle.ConclusionThe majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference.Cite this article: Bone Joint Open 2020;1-9:549–555.

Fracturas marginales volares de radio distal: fijación con clavijas adicionales a la placa volar.

Introducción: El tratamiento de las fracturas de muñeca con placas volares bloqueadas puede ser insuficiente para las fracturas con fragmentos volares marginales distales a la línea de inserción distal del pronador cuadrado, sitio de inserción de importantes ligamentos. Objetivo: Evaluar la reproducibilidad de la técnica y los resultados del tratamiento de fracturas marginales volares de radio distal con clavijas, capturando el fragmento volar y dejándolas debajo de la placa volar bloqueada de radio distal. Materiales y Métodos: La técnica quirúrgica utiliza una o varias clavijas para fijar el fragmento volar semilunar del radio distal, bloqueándolas debajo de la placa. Inicialmente efectuamos una simulación cadavérica. Luego, realizamos un estudio retrospectivo que incluyó a 7 pacientes con fracturas de radio distal intrarticular con un fragmento marginal volar distal a la línea de la orilla, tratados entre septiembre de 2014 y febrero de 2015. El promedio de edad era de 53 años, y el del seguimiento, de 16 meses. Se obtuvieron radiografías en sucesivos controles. Al alta se evaluaron el rango de movilidad, la fuerza de prensión y dos puntajes funcionales. Resultados: Todas las fracturas consolidaron satisfactoriamente manteniendo la reducción del fragmento marginal volar. No hubo casos con inestabilidad radiocubital inferior como secuela. Conclusión: La fijación adicional del fragmento marginal volar lunar del radio con clavijas dobladas por debajo de la placa ofrece una alternativa de estabilización sencilla, económica y adecuada para suplir la fijación de un fragmento que la placa sola no estabilizaría adecuadamente.
 Nivel de Evidencia: IV

Prognostic Factors Affecting Clinical Outcomes of Arthroscopic Assisted Reduction and Volar Plating through Preservation of Pronator Quadratus for Intra-Articular Distal Radius Fracture.

Background: This study aimed to evaluate the clinical and radiological outcomes following an arthroscopic-assisted reduction and volar plating (AR-VP) surgery through pronator quadratus (PQ) preservation for treating intra-articular distal radius fractures (IA-DRFs) and to assess prognostic factors that affect functional outcomes. Methods: Between March 2014 and February 2017, 54 patients who had intra-articular DRF and underwent AR-VP through the PQ preservation technique and completed 1-year follow-up were enrolled. Patients were divided into the satisfactory group (excellent and good results) and an unsatisfactory group (fair and poor results) based on the modified Mayo Wrist Scoring System (MMWS) scored at 1-year follow-up to determinate prognostic factors that affected clinical outcomes. Patients' demographics, clinical outcome measures (VAS, DASH, PRWE, etc.), and pre-and post-operative radiographic parameters were analyzed. Results: The outcomes according to MMWS were 10 excellent, 22 good, 14 fair, and 8 poor. A univariate analysis showed a significant difference between the groups (p < .05) for all radiographic parameters, sex, and the presence of an intra-articular comminution. In the multivariate analysis, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to uninjured wrist (> 20.1°) at trauma were considered as significant poor prognostic factors of functional outcome. Conclusions: AR-VP surgery through PQ preservation for intra-articular DRFs has reliable clinical and radiological outcomes. However, female gender, presence of an intra-articular comminution, and difference of palmar articular tilt compared to the uninjured wrist (> 20.1°) at initial injury were considered poor prognostic factors for AR-VP through PQ preservation for intra-articular DRF.

Prevalence of Flexor Carpi Radialis Brevis in Chinese Patients with Volar Wrist Plating Performed for Distal Radius Fracture.

Background: Volar locking plates were increasing popular as treatment of distal radius fractures. Various distal forearm anatomical variants were encountered during surgery. Flexor carpi radialis brevis (FCRB) was one of the most common and relevant anatomical variants because of its close proximity to fracture site. Methods: This is a retrospective single-centre study. In a 3.5-year period from March 2015 to August 2018, 133 patients who suffered from distal radius fracture requiring volar wrist plating were identified. Operation records and clinical photos were reviewed. All patients were followed up for at least 1 year. Any complications were recorded. Results: 9 patients with FCRB variant were identified. The prevalence was 6.8%. Hypoplastic pronator quadratus were found in 5 cases out of the 9 cases. None of these cases had any neurovascular injuries. No complications were noted during follow-up at 1 year. Conclusions: In Chinese population with volar locking plate done for distal radius fracture, the prevalence of flexor carpi radialis brevis was 6.8%. Surgeons should be aware of the possibility of FCRB variant.

Effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults

To investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults. The clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group ( P<0.05). Patients in both groups were followed up 6-30 months, with an average of 13 months. The VAS score and ROM of wrist of the observe group at 3 days after operation were superior to the control group ( P<0.05), but there was no significant difference between the two groups at 3 months after operation ( P>0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups ( χ 2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) ( χ 2=9.325, P=0.002). It is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.

Do we need to suture the pronator quadratus muscle when we do open reduction and internal fixation for fracture of the distal radius

BackgroundOpen reduction and internal fixation is often used for the treatment of distal radius fracture. Opening the pronator quadratus muscle during the process of open reduction and internal fixation is necessary to achieve sufficient exposure. Therefore, knowledge on how to suture the pronator quadratus muscle will be of essence.AimThe aim of the present study was to determine if suturing the pronator quadratus during the treatment of the distal radius fracture can enhance limb function .MethodsA total of 126 patients were enrolled for the study. The patients underwent open reduction and internal fixation. During the procedure, the pronator quadratus was cut open to allow insertion of the plate. The pronator quadratus muscles of the patients were stitched together before the surgery was completed. After the fracture healed, the patients underwent surgery to remove the internal fixations. Patients received wrist function scores prior to removal of the internal fixations. Healing of the pronator quadratus was during surgery. Patients were grouped according to the healing of the pronator quadratus. Functional scores between the two groups were compared.ResultsMuscle healing was observed in 23 patients during surgery. However, the PQ muscles of these patients were remarkably atrophic, with scar hyperplasia and fibrosis. The muscle fibers were loose, thin, and had decreased in number. The remaining muscle fibers presented different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. A total of 23 patients were included in group A and 103 patients in group B based on the intraoperative condition. No statistically significant differences was observed in age and type of fracture between group A and group B. In addition, no statistically significant differences was observed in the isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups.ConclusionThis study demonstrates that healing of the PQ muscle does not affect the outcomes of volar plating for distal radius fractures with reference to the isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores. The results of this study support our current practice of PQ muscle incision.

The correlation between pre-operative ultrasonographic median nerve evaluation and the operative procedure in CTS

BackgroundUltrasonography is a convenient non-invasive diagnostic tool with wide availability and cost effectiveness. Musculoskeletal ultrasonography is a growing field used for diagnosis of many musculoskeletal disorders; carpal tunnel syndrome (CTS) could be one of these disorders. The purpose of this study was to assess the impact of median nerve ultrasonography in carpal tunnel syndrome on surgical management, and its added value in operative techniques selection, and in tailoring the surgical steps. Thirty patients with CTS and thirty normal subjects underwent superficial ultrasonography. The cross-sectional area at different levels and flattening ratios were measured on both groups. The patients who had failed conservative treatment had surgical carpal tunnel release.ResultsThere was significant positive correlation between the need for external neurolysis with increased flattening ratio with cutoff values > 4, and between the need for approach extension with increased cross-sectional area difference between pisiform level and pronator quadratus level with cutoff values of cross-sectional area difference > 7.ConclusionsUltrasonographic measurements of median nerve in CTS could be helpful in selection and modification of operative procedure including the surgical approach and need for neurolysis.

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

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.

Targeted Muscle Reinnervation for Symptomatic Neuromas Utilizing the Terminal Anterior Interosseous Nerve.

Summary:Sensory nerve trauma at the level of the wrist can lead to debilitating neuromas. Targeted muscle reinnervation (TMR) is an effective therapy for the treatment of neuromas. Here we propose the use of the terminal anterior interosseous nerve (AIN) as a viable recipient for TMR. All superficial sensory nerves around the wrist, including the dorsal ulnar sensory nerve, the distal lateral antebrachial cutaneous nerve, the distal branches of the superficial branch of the radial nerve, and the palmar cutaneous branch of the median nerve were dissected in 2 cadaver specimens. The AIN branch to pronator quadratus was divided just distal to the final branch of flexor pollicis longus to preserve adequate length for TMR. The sensory nerves at the wrist were fully dissected to identify a viable location for coaptation to the AIN. After the cadaveric concept was demonstrated, the technique was successfully used in a clinical case. In summary, the distal AIN is a versatile recipient for TMR as a treatment of painful sensory neuromas at the level of the wrist, with minimal donor-site morbidity.

Anterior Interosseous Nerve Syndrome due to Extravasation of Intravenous Infusion

Anterior interosseous nerve is a motor branch from median nerve. It innervates three muscles, the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus muscles in the forearm. Anterior interosseous nerve syndrome refers to a neuropathy affecting this nerve, to develop weakness of innervated muscles. The etiology can be diverse and the pathophysiology is not clearly documented. We report a case of a 67-year-old male patient with diabetes, who presented symptoms of right thumb and index finger weakness, forearm pain, which was in conclusion diagnosed as anterior interosseous nerve syndrome through electrodiagnostic studies. His anterior interosseous nerve syndrome was revealed as due to fluid extravasation. Fluid extravasation can cause various side effects, and peripheral nerve injury is an uncommon side effect. This is a rare case of anterior interosseous nerve syndrome developed from fluid extravasation. Keywords: Neuropathy; Extravasation

Endoscopically Assisted Myectomy for Intramuscular Lipoma of Pronator Quadratus

Intramuscular lipoma is usually growing infiltratively and can affect any muscle, although the proximal muscles of the extremities are mostly commonly involved. This lesion can occur in the pronator quadratus. Because of muscle is small and deep seated, the intramuscular lipoma usually involves the whole muscle and even has an extramuscular component before it presents clinically. In this Technical Note, we report the technique of endoscopically assisted myectomy of the pronator quadratus for infiltrating intramuscular lipoma of the muscle. This has the advantage of minimally invasive surgery of minimal soft tissue dissection and fewer soft tissue complications.

Clinical and ultrasonographical follow-up after standard removal of distal radius volar plates positioned distal to the watershed line.

Marginal fracture types of the distal radius may require volar plate positioning distal to the watershed line. Subsequently, plate prominence with direct friction with the flexor tendons occurs which is associated with flexor tendon pathology. Standard plate removal can be proposed. This cohort study examined clinical outcome, patient satisfaction and ultrasonographical assessment of the relation of the flexor pollicis longus (FPL) and the volar rim after standard plate removal. Twenty patients with volar plate prominence after osteosynthesis for distal radius fractures were included. Plate removal was performed at least 4months after initial surgery. The mean age was 60years (range 39-84). The average delay from hardware removal to assessment was 2.9years (range 1.0-5.0years). Mean flexion, extension and radial deviation were significantly decreased (p < 0.05) compared to the contralateral side, while ulnar deviation, pro- and supination and grip strength were not. Mean QuickDASH score was 21.5. 85% of patients described their result as good to excellent. 80% would undergo the intervention again. During ultrasonography, distance from FPL to volar rim remained significantly decreased compared to the uninjured side in neutral and flexed position (p < 0.05) despite plate removal. The largest distance between the FPL and the volar cortical bone, which is mainly occupied by the pronator quadratus, did not differ. In this study, the range of motion and FPL distance to the distal radius normalized only partially compared to the uninjured wrist after standard plate removal.

Evaluation of Flexor Pollicis Longus Tendon Rupture after Treatment of Distal Radius Fracture with the Volar Plate.

Background The aim of this study is to evaluate the frequency of flexor pollicis longus (FPL) tendon rupture and factors leading to this rupture during the follow-up of patients who underwent volar plate fixation because of distal radius fracture. Patients and Methods A total of 109 distal radius fractures of 102 patients treated with volar plate fixation and periodically followed up for at least 1 year between January 2013 and May 2018 were evaluated. Fractures were categorized according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) Fracture-Dislocation Classification and Soong's grading was used for classifying volar plate position. All patients operated were inquired retrospectively in terms of flexor tendon rupture. Results Gender distribution revealed 45 females and 57 males. Mean age was 47.9 (range: 17-88) years. Mean period of follow-up was 27 months. Distribution of fractures in accordance with the AO/OTA distal radius classification was 6, 8, 7, 12, 24, 33, 11, and 8 patients with types A2, A3, B1, B2, B3, C1, C2, and C3, respectively. When volar plate positions were analyzed with Soong's classification, it revealed that 79 (72.4%), 23 (21.1%), and 7 (6.5%) plates were grade 0, 1, and 2, respectively. In total, evaluating the three patients with FPL rupture, it revealed that the volar plate was positioned distally during fixation because the fracture line had advanced to the distal of the watershed line, the distal portion of the plate had lost complete connection with the bone, and at this portion, it was observed that the pronator quadratus muscle was not covering the plate entirely (Soong's classification grade 2). Patients did not have additional flexor tendon injury. Conclusion FPL tendon rupture is a rare but serious complication of volar plate fixation performed for distal radius fractures. We believe that appropriate choice of implant and careful surgical technique, along with the close follow-up of patients, with Soong's classification grade-2 volar positions would help in preventing this complication. Level of Evidence This is a Level 3a, differential diagnosis/symptom prevalence study.

Does Surgical-site Multimodal Drug Injection After Palmar Plating of Distal Radius Fractures Improve Pain Scores?

Does Surgical-site Multimodal Drug Injection After Palmar Plating of Distal Radius Fractures Improve Pain Scores?

Pronator Quadratus to Extensor Carpi Radialis Brevis Nerve Transfer in C5-C7 or C5-C8 Brachial Plexus Injuries for Independent Wrist Extension.

Background Patients with lesions affecting C7 and C8 roots (in addition to C56) demonstrate loss of independent wrist dorsiflexion in addition to loss of shoulder abduction and elbow flexion. Traditionally, this deficit has been addressed using tendon transfers after useful function at the shoulder and elbow has been restored by primary nerve surgery. Confidence with nerve transfer techniques has prompted attempts to replace this method by incorporating procedures for wrist dorsiflexion in the primary operation itself. Aim The objective of this study was to report the results of pronator quadratus motor branch transfers to the extensor carpi radialis brevis motor branch to reconstruct wrist extension in C5–C8 root lesions of the brachial plexus. Patients and Methods Twenty-three patients, average age 30 years, with C5–8 root injuries underwent operations an average of 4.7 months after their accident. Extrinsic extension of the fingers and thumb was weak or absent in two cases while the remaining 18 patients could open their hand actively. The patients lacked independent wrist extension when they were examined with the fingers flexed as the compensatory action of the extrinsic finger extensors was removed. The average follow-up was 21 months postoperative with the minimal follow-up period was at least 12 months. Results Successful reinnervations of the extensor carpi radialis brevis (ECRB) were demonstrated in all patients. In 17 patients, wrist extension scored M4, and in 3 patients it scored M3. Conclusions The pronator quadratus (PQ) to ECRB nerve transfer in C5–C7 or C5–C8 brachial plexus injuries for independent wrist extension reconstruction gives consistently good results with minimal donor morbidity.

How Close Are the Volar Wrist Ligaments to the Distal Edge of the Pronator Quadratus? An Anatomical Study.

Background: This cadaveric study defines the interval distance between the proximal insertion of the volar wrist ligaments and the distal edge of the pronator quadratus on the distal radius. It is important to be aware of this distance during surgical dissection for placement of volar locking plates for wrist fractures. Disruption of the volar wrist ligament insertion may have adverse biomechanical consequences such as carpal instability, which can lead to pain and eventually wrist arthritis. Methods: Thirteen cadaveric wrists were dissected using the trans-flexor carpi radialis volar approach to identify relevant anatomy. The distance between the distal border of the pronator quadratus and the most proximal insertion of the volar wrist ligaments was measured. Results: The average distance between the pronator quadratus and the proximal insertion of the volar wrist ligaments was 5 mm, with a standard deviation of 2 mm. Conclusions: The volar wrist ligaments insert quite near the distal end of the pronator quadratus. Surgeons should be cognizant of the proximity of the volar wrist ligaments and be judicious with subperiosteal stripping of the distal fragment during volar plating procedures.

Radioskapholunäre Arthrodese mit Entfernung des distalen Skaphoidpols von palmar

Radioscapholunate (RSL) arthrodesis with distal scaphoidectomy using an angular stable plate and palmar access in post-traumatic or degenerative osteoarthritis limited to the radiocarpal joint. Osteoarthritis limited to the radiocarpal joint with intact mediocarpal joint after malunited intra-articular distal radius fractures, rheumatoid osteoarthritis, scapholunate advanced collapse (SLAC) up to stageII. Mediocarpal osteoarthritis, poor patient compliance, SLAC from stageIII, osteitis. The palmar RSL arthrodesis is performed using the palmar approach between the flexor carpi radialis tendon and the radial artery. After releasing the pronator quadratus muscle, alongitudinal capsulotomy is performed and the radiocarpal joint is inspected. After correction of avolar or dorsal intercalated segmental instability of the lunate, the lunate is temporarily fixed to the scaphoid using aK-wire. The distal quarter of the scaphoid and the palmar rim of the distal radius is resected and the cartilage between the scaphoid, lunate and distal radius is removed. The scaphoid and lunate are temporarily fixed to the distal radius using K‑wires. Under image intensifier control the angular stable low-profile plate (e.g., volar 2.5 Trilock RSL Fusion plate [Medartis® Aptus® Basel, Switzerland]) is fixed to the distal radius in the long-leg hole. The scaphoid and lunate are fixed distally with two screws each. The carpus is pushed distally using aCodeman distractor and the cancellous bone graft is impacted. Finally, the shaft is fixed with angular stable screws. Immobilization using aplaster cast or thermoplastic short-arm orthosis for 5weeks. After 2weeks, the orthosis can be removed during hand therapy with active wrist and finger exercises. Normal activities permitted after 12 weeks. Palmar RSL arthrodesis and distal scaphoidectomy using angular stable plate fixation shows ahigh union rate and pain relief while maintaining good residual mobility of the wrist.

Residual rotation of forearm amputation: cadaveric study

BackgroundThe purpose of this study was to investigate residual rotation of patients with forearm amputation and the contribution of involved muscle to residual rotation.MethodsTesting was performed using five fresh-frozen cadaveric specimens prepared by isolating muscles involved in forearm rotation. Amputation was implemented at 25 cm (wrist disarticulation), 18 cm, or 10 cm from the tip of olecranon. Supination and pronation in the amputation stump were simulated with traction of involved muscle (supinator, biceps brachii, pronator teres, pronator quadratus) using an electric actuator. The degree of rotation was examined at 30°, 60°, 90°, and 120° in flexion of elbow.ResultsAverage rotation of 25 cm forearm stump was 148° (SD: 23.1). The rotation was decreased to 117.5° (SD: 26.6) at 18 cm forearm stump. It was further decreased to 63° (SD 31.5) at 10 cm forearm stump. Tendency of disorganized rotation was observed in close proximity of the amputation site to the elbow. Full residual pronation was achieved with traction of each pronator teres and pronator quadratus. Although traction of supinator could implement residual supination, the contribution of biceps brachii ranged from 4 to 88% according to the degree of flexion.ConclusionsClose proximity of the amputation site to the elbow decreased the residual rotation significantly compared to residual rotation of wrist disarticulation. The preservation of pronosupination was 80% at 18 cm forearm stump. Although the pronator teres and the pronator quadratus could make a full residual pronation separately, the supinator was essential to a residual supination.

Clinical outcome and evaluation of patients with distal end radius fractures operated with volar plate and pronator quadratus repair versus no repair

Introduction: Dista l radi us fracture is the commonest fracture of upper extremity that we found during emergency or during orthopaedic practice, Now a days volar plating is more commonly perfomed surgery for the same. During this type of surgical exposure pronator quadrtus muscle is vital structure to come across and for this separation of muscle from radius must be done but after plate placement there is controversy regarding the repair of muscle is there. Repair of pronator quadratus muscle after plate fixation will protect volar flexo r tendon by covering the implant and also helpfull in pronation. Conversely if tight closure done its lead to ischemic contracture and its lead to limited wrist supination and pronation. Materials and Methods: This study was conducted on 30 patients having distal radius fractures operated with volar plating done by trained orthopaedic surgeon at our hospital in B. J. medical college, Civil hospital Ahmedabad between january 2017 and January 2019. The mean follow- up time was approximately 24 months. A standard volar approach was used and PQ muscle was separted from radius side and repaired after fracture fixation and were followed up post operatively. Result: Repair of pronator quadratus after volar radius plate fixation is depends on surgeon choice, here we have compaired our result with erlier study to evaluate the benefits, outcome and prognosis of patients post-operatively. Conclusion: After pronator quadratus repair pain reduced in early postoperative period but pronation strength in early post- operative rehabilitation period could not be confirmed, And both the patients give satisfactory and almost similar results with full range of movements and early mobilization. We recommended to repair PQ muscle to protect flexor tendons. Keywords: Distal radius fracture, Volar plate, Pronator quadratus, Radius, Ellis plating, Volar barton’s fracture, Buttress plate.

Is Pronator Quadratus Affected In Volar Approach To Distal Radius Fractures?

Objective: One of the structures encountered in surgical incision in volar Henry approach to distal end of the radius is the pronator quadratus (PQ) muscle. It may be preferable to repair the PQ after the surgery on radius, but due to the structure of the muscle tissue, the success of repair and therefore repair indications are still controversial. Therefore, in this study, we aimed to evaluate the PQ muscle placement and functional conclusions of patients with radial distal end fractures treated with volar locking plate. Methods:74 patients with closed distal radius fractures who underwent osteosynthesis with volar plate, are over 18 year were evaluated. Quick DASH, Stewart Scoring Board, AO classification, Frykman classification, thickness of the PQ muscle with USG, ranges of motion of wrist and grip strengths were recorded. Results:In 26 patients with PQ repair and 48 without PQ repair; no significant difference was found in QDASH scores (p=0.954), grip strength (p=0.300), ranges of motion of wrist and Stewart scores. No statistically significant thickness difference was found in USG transverse (p=0.312) and longitudinal (p=0.137) measurements made in patients with or without repair. Loss of thickness compared to the intact side was found as 15.4% in all patients. Conclusion:We found that PQ repair had no significant effect on range of motion of wrist, QDASH score or grip strength. We found an average 15.4% atrophy whether it was repaired or not. We believe that the portion of PQ removed from the radius does not affect the function of hand.