Clin Orthop Surg.  2014 Sep;6(3):267-272. 10.4055/cios.2014.6.3.267.

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

• Nho JH
• Gong HS
• Song CH
• Wi SM
• Lee YH
• Baek GH

• KMID: 1794706
• DOI: http://doi.org/10.4055/cios.2014.6.3.267

Abstract

BACKGROUND
It 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.
METHODS
We 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.
RESULTS
The 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.
CONCLUSIONS
This 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.

Keyword

Distal radius fracture; Volar plating; Pronator quadratus; Isokinetic strength

MeSH Terms

Adult
Aged
Bone Plates
Device Removal
Female
Forearm/physiopathology/surgery
Fracture Fixation, Internal/*methods
Hand Strength
Humans
Male
Middle Aged
Muscle Strength
Muscle, Skeletal/physiopathology/*surgery
Radius Fractures/radiography/*surgery
Range of Motion, Articular
Wound Healing
Young Adult

Figure

• 

  Fig. 1 Intraoperative photograph of the pronator quadratus (PQ) muscle covering the volar plate. The length of the healed PQ muscle was measured using a ruler at 2 cm proximal to the distal radioulnar joint between the lateral border of the ulna and the lateral margin of the muscular part along the direction of its fibers (B). For the reference length of the PQ muscle, we measured the length between the lateral border of the ulna and the lateral border of the radius (A). The relative length of the PQ muscle was calculated as B/A (%).

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