Background The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails. Aim The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures. Methods Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy and complications of patients were recorded and evaluated. Results All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and pain-related visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant. Conclusion The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.

Background: For the treatment of long bone defects of the extremities caused by trauma, infection, tumors, and nonunion, it has been a challenge for clinical orthopedic surgeons. Bone transport technique have become the only way to treat bone defects. However, inevitable docking site complications related to bone transport technique have been reported by many studies. The purpose of this study was to evaluate risk factor of docking site complications of bone transport technique using Ilizarov method in the treatment of bone defect of lower extremity. Aim: The purpose of this study was to investigate the risk factors associated with docking site complication treated with Ilizarov bone transport technique in the treatment of tibial bone defect. Methods: The retrospective study including 103 patients who underwent bone transport for the treatment of large bone defect in tibia from October 2012 to October 2019. There were 90 male and 13 females with a mean age of 37 years (range 17-66years). The etiology of bone defect includes high-energy trauma in 25 cases, osteomyelitis in 61 and nonunion in 17. There were 19 cases in the proximal 1/3 of the diaphysis, middle 1/3 in 39 and distal 1/3 in 45 cases. There were 12 limbs in active infected state with sinus and drainage.17 patients suffered soft tissue defect after debridement. The mean bone defect was 6.6cm (range 3-13cm). Single bone transport in 80 cases, and double in 23 cases. The docking time, external fixation time, external fixation index, and docking site complications were documented and analyzed. Univariate analysis and logistic regression analysis were used to analyze the factors that may affect the docking site complication of tibial bone defect treated with Ilizarov bone transport technique. The clinical outcomes were evaluated using Association for the Study and Application of the method of Ilizarov criteria (ASAMI) at last clinical visit. Results: 103 patients were followed up for (24-48) months, with an average of 27.5 months, The soft tissue were successfully managed by musculocutaneous flap transfer in 17 cases. However, multiple complications occurred in docking site, with an average of 0.53 complications per patient, an average of 0.16 minor complications and 0.38 major complications per patient. Delayed union in 22 cases (21.4%), axial deviation in 19 cases (18.4%) and soft tissue incarceration in 10 cases (9.7%). According to the results of logistic regression analysis, the distance of bone defect (P=0.001,OR=1.976), and distal 1/3 (P=0.01,OR =1.976) were are risk factors for delayed union. Bone defect distance (P< 0.001, OR = 1.981), external fixation time (P = 0.012, OR= 1.017) were risk factors for axial deviation. Soft tissue defect (P=0.047,OR =6.766) and the number previous operation (P=0.001, OR =2.920) were risk factors for soft tissue incarceration. Base on ASAMI bone score, bony result was excellent in 91 patients, good in 7, fair in 3 and poor in 2. The ASAMI functional result was excellent in 67 patients, good in 26, fair in 8, poor in 2. Conclusion: Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect distance, external fixation time, the number of previous operations, soft tissue defects and the distal 1/3 are risk factors for complications at the docking site, and clinicians should pay attention to them.

Background: The most commonly used approach for distal radius fractures is the traditional Henry approach. However, it requires an intraoperative incision of the pronator quadratus (PQ) muscle, which results in a series of complications if the repair of the PQ fails.Aim: The objective of this study was to investigate the efficacy of sparing the pronator quadratus for volar plating of the distal radius fractures.Methods: Seventy-six patients who suffered from distal radius fractures of types 23-B, 23-C1, and 23-C2 as per the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification were treated with volar locking plate fixation using either the PQ muscle incision and repair (group A, n = 39) or the PQ muscle preservation approach (group B, n = 37). Intraoperative index, postoperative efficacy, and complications of the patients were evaluated.Results: All patients were followed up for more than one year after surgery. All fractures achieved union. There were significant differences in mean operative time, mean intraoperative blood loss, and mean fracture healing time between the two groups. Still, there were no significant differences in limb function scores between the two groups at the 12-month postoperative follow-up. Outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the mean range of motion and the visual analog scale (VAS) between the two groups. As the range of motion and grip strength increased, the VAS scores decreased, and there was no significant difference between the two groups at 12 months postoperatively. Although tendon irritation and delayed carpal tunnel syndrome were more common in group A than in group B (7.6% vs. 0% and 5.1% vs. 0%, respectively), the differences were not statistically significant.Conclusion: The modified Henry approach with sparing pronator quadratus muscle has no significant advantage in the range of wrist motion and upper limb function in the late stage. Nevertheless, the intraoperative placement of the plate under the pronator quadratus muscle can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, promote early activity, and improve the patient's quality of life. It is recommended that the pronator be preserved at the time of surgery.