A systematic review and meta-analysis of the pronator quadratus repair following volar plating of distal radius fractures

Abstract

Background Distal radius fracture (DRF) is the most common upper extremity fracture that requires surgery. Operative treatment with a volar locking plate has proved to be the treatment of choice for unstable fractures. However, no consensus has been reached about the benefits of pronator quadratus (PQ) repair after volar plate fixation of DRF in terms of patient-reported outcome measures, pronation strength, and wrist mobility. Methods We searched the PubMed, Embase, Cochrane Central, and China National Knowledge Infrastructure (CNKI) databases up to March 13, 2020, and included randomized-controlled, non-randomized controlled, or case-control cohort studies that compared cases with and without PQ repair after volar plate fixation of DRF. We used a random-effects model to pool effect sizes, which were expressed as standardized mean differences (SMDs) and 95% confidence intervals. The primary outcomes included Disabilities of the Arm, Shoulder, and Hand scores and pronation strength. The secondary outcomes included the SMDs in pain scale score, wrist mobility, and grip strength. The outcomes measured were assessed for publication bias by using a funnel plot and the Egger regression test. Results Five randomized controlled studies and six retrospective case-control studies were included in the meta-analysis. We found no significant difference in primary and secondary outcomes at a minimum of 6-month follow-up. In a subgroup analysis, the pronation strength in the PQ repair group for AO type B DRFs (SMD = − 0.94; 95% CI, − 1.54 to − 0.34; p < 0.01) favored PQ repair, whereas that in the PQ repair group for non-AO type B DRFs (SMD = 0.39; 95% CI, 0.07–0.70; p = 0.02) favored no PQ repair. Discussion We found no functional benefit of PQ repair after volar plate fixation of DRF on the basis of the present evidence. However, PQ muscle repair showed different effects on pronation strength in different groups of DRFs. Future studies are needed to confirm the relationship between PQ repair and pronation strength among different patterns of DRF. Registration This study was registered in the PROSPERO registry under registration ID No. CRD42020188343. Level of evidence Therapeutic III

Evaluation of sparing the pronator quadratus for volar plating of distal radius fractures: a retrospective clinical study

“…Fenglei Shi concluded in a study that whether or not to repair the PQ muscle may not improve late wrist function in patients [ 18 ]. However, Chun-Kuan Lu suggested that repairing the PQ muscle may have some effects on pronation strength, and it is uncertain whether repairing the PQ is a protective factor in preventing flexor tendon complications [ 19 ].…”

Does pronator quadratus repair affect functional outcome following volar plate fixation of distal radius fractures? A systematic review and meta-analysis

“…Besides, there was no statistical difference in wrist function between the repair group and the non-repair group was found in their study. Lu et al performed a meta-analysis and found that PQ muscle repair showed different effects on pronation strength in different groups (32).We conducted a subgroup analysis by the length of follow-up time and the results showed that the significant difference in pronation angle between the two groupsafter short-term and long-term follow-up. Both previous articles included some retrospective studies, and the level of evidence Risk of bias summary: review authors' judgments about each risk of bias item for each included study.…”

Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus

“…Flexor tendinitis including tendon rupture is a possible complication. Lu et al [33] advocated that repair of PQ muscle might have a slight effect on pronation function, but it was not certain whether repair of pronator muscle was a protective factor to prevent exor tendon complications. Most clinicians believed that plate placement and PQ muscle maintenance played a signi cant role in prevention.…”