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: 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.

Background The conventional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, releasing PQ muscle could cause loss of function and a host of complications.Aim This study compared the outcomes of different methods of sparing the PQ muscle combined with volar plate in the treatment of distal radius fractures.Methods A total of 68 patients with distal radius fractures were enrolled with either the brachioradialis (BR) splitting approach (Group A,33 people) or through the tunnel behind the PQ muscle approach (Group B,35 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the two groups. The visual analog scale (VAS) of postoperative wrist pain was compared between the two groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy.Results A total of 68 patients with distal radius fractures were followed up for more than 1 year after surgery. All fractures obtained good union, with no vascular injury, nerve injury, or wound infection. There was no significant difference in the baseline characteristics of both groups. Outcomes at 3 days,1 month,and 3 months all showed no significant differences in postoperative imaging indexes between the two groups. There were significant differences in the mean operative time between the two groups. Nevertheless, no significant differences were shown in mean operative blood loss and mean bone union time between the two groups. There was no significant difference in the results of complications between the two groups. No significant differences in limb function scores, VAS scores and the mean range of motion existed the two groups at the 12-month postoperative follow-up. However, outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the VAS scores and the mean range of motion between the two groups.Conclusion Our results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. Placing the plate under the quadratus muscle could reduce early postoperative pain, promote early activity, and returned to normal life. The BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. Therefore, surgeons should be aware of their individual characteristics and chose patients carefully.