Die topografische Beziehung des M. pronator quadratus zum Ansatz des M. brachioradialis - Implikationen für die Refixation nach palmarer Plattenosteosynthese distaler Radiusfrakturen

Ries, Christian; Maier, Jacob; Wegmann, Kilian; Zhang, W.; Hohendorff, B.; Skouras, Emmanouil; Müller, Lars Peter; Burkhart, Klaus J.

doi:10.1055/s-0032-1328493

Cited by 5 publications

(2 citation statements)

References 12 publications

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“…In contrast, various suture techniques for re-fixation of the PQ are described in the literature. These include the simple interrupted suture, the braided suture, the suture combined with prolonged immobilisation or the suture of the PQ together with connective tissue fibres from the first extensor tendon compartment or the palmar limb of the brachioradialis tendon [22,23].…”

Section: Discussionmentioning

confidence: 99%

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

Falk

Maksimow

Mittlmeier

et al. 2023

Arch Orthop Trauma Surg

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Introduction Palmar plate fixation of the distal radius fracture involves dissecting the pronator quadratus (PQ). This is regardless of whether the approach is radial or ulnar to the flexor carpi radialis (FCR) tendon. It is not yet clear whether and to what extent this dissection leads to a functional loss of pronation or pronation strength. The aim of this study was to investigate the functional recovery of pronation and pronation strength after dissection of the PQ without suturing. Materials and methods From October 2010 to November 2011, patients aged over 65 with fracture were prospectively enrolled in this study. Fracture stabilisation was performed via the FCR approach without suturing the PQ. Follow-up examinations took place 8 weeks and 12 months postoperatively, and pronation and supination strength were analysed by means of an especially developed measuring device. Results 212 patients were initially screened and 107 were enrolled. The range of motion compared to the healthy opposite side was Ext/Flex 75/66% 8 weeks postoperatively. Pronation was 97% with a pronation strength of 59%. After 1 year, the scores improved to Ext/Flex 83/80%. Pronation recovered to 99% and pronation strength to 78%. Conclusion The present study can show a recovery of pronation as well as pronation strength in a large patient population. At the same time, the pronation strength is still significantly lower 1 year after the operation than on the opposing healthy side. As the pronation strength recovers as the grip strength and is at all times on a par with the supination strength, we believe that we can continue to refrain from re-fixating the pronator quadratus.

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Section: Discussionmentioning

confidence: 99%

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

Falk

Maksimow

Mittlmeier

et al. 2023

Arch Orthop Trauma Surg

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“…Der Schonung des M. pronator quadratus wird bei der Umwendbewegung des Unterarms eine wichtige Rolle zugesprochen. In einer Untersuchung an 12 in Formalin fixierten Leichenunterarmpaaren konnten Ries und Mitarbeiter feststellen, dass der Muskel über 4,75 cm radial distal fixiert ist und hier den wichtigsten Ansatzort hat [6]. Gerade dieser Ansatz wird beim konventionellen Zugang häufig deinseriert oder der Muskel mittig gespalten, um den distalen Radius zu erreichen.…”

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Ein neuer Zugang zur minimalinvasiven palmaren Plattenosteosynthese bei distaler Radiusfraktur

Chmielnicki

Prokop

2015

Z Orthop Unfall

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Distal radius fractures are among the most common fractures. Types A3 and C2 make up almost half of these. Volar fixed-angle plate fixation is the gold standard of treatment today. We wanted to minimise the approach to the distal radius through a transverse 2-3 cm incision in the wrist flexor fold, tunnelling beneath the pronator muscle. The operative technique is demonstrated here. 11 patients, averaging 70 years of age, underwent surgery for 7 A3 and 4 C2 type fractures. Average operating time was 50 minutes. Length of admission averaged 2.9 days. Using a visual analogue scale, pain decreased from 6/10 preoperatively to 3/10 on post-op day one and 2/10 on post-op day three. After 6 weeks, flexion and extension averaged 45-0-45°, and radial and ulnar deviation 20-0-20°. Pronation and supination averaged 85-0-85°. Grip strength with manometer averaged 90 % compared to the contralateral side at 6 weeks and 96 % at 3 months. As comparison, from 1 January 2008 until 31 May 2013, we treated 908 patients with distal radius fractures with volar fixed-angle plates through a conventional longitudinal incision of 5-8 cm. The average skin to skin time was 46 minutes, with an average length of admission of 5.6 days. A minimally invasive approach to treat distal radius fractures with volar plate fixation and sparing of the pronator muscle is possible. The initial patients treated with this approach experienced minimal post-operative pain, shorter hospital admissions, and rapid grip strength recovery with almost undisturbed rotational motion.

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Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial

Hohendorff

Knappwerth

Franke

et al. 2018

Arch Orthop Trauma Surg

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Die topografische Beziehung des M. pronator quadratus zum Ansatz des M. brachioradialis - Implikationen für die Refixation nach palmarer Plattenosteosynthese distaler Radiusfrakturen

Cited by 5 publications

References 12 publications

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

Ein neuer Zugang zur minimalinvasiven palmaren Plattenosteosynthese bei distaler Radiusfraktur

Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial

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