Do we need to suture the pronator quadratus muscle when we do open reduction and internal fixation for fracture of the distal radius

Abstract

Background: Open reduction and internal fixation is often used for the treatment of distal radius fracture. Opening the pronator quadratus muscle during the process of open reduction and internal fixation is necessary to achieve sufficient exposure. Therefore, knowledge on how to suture the pronator quadratus muscle will be of essence. Aim: The aim of the present study was to determine if suturing the pronator quadratus during the treatment of the distal radius fracture can enhance limb function. Methods: A total of 126 patients were enrolled for the study. The patients underwent open reduction and internal fixation. During the procedure, the pronator quadratus was cut open to allow insertion of the plate. The pronator quadratus muscles of the patients were stitched together before the surgery was completed. After the fracture healed, the patients underwent surgery to remove the internal fixations. Patients received wrist function scores prior to removal of the internal fixations. Healing of the pronator quadratus was during surgery. Patients were grouped according to the healing of the pronator quadratus. Functional scores between the two groups were compared. Results: Muscle healing was observed in 23 patients during surgery. However, the PQ muscles of these patients were remarkably atrophic, with scar hyperplasia and fibrosis. The muscle fibers were loose, thin, and had decreased in number. The remaining muscle fibers presented different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. A total of 23 patients were included in group A and 103 patients in group B based on the intraoperative condition. No statistically significant differences was observed in age and type of fracture between group A and group B. In addition, no statistically significant differences was observed in the isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups. Conclusion: This study demonstrates that healing of the PQ muscle does not affect the outcomes of volar plating for distal radius fractures with reference to the isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores. The results of this study support our current practice of PQ muscle incision.

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

“…The typical anatomical structure of the PQ muscle is the basis of its function [ 40 ]. It was found that the PQ muscles were heavily scarred, significantly atrophied, and adhered to the surrounding tissue after suturing.…”

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

“…Fang et al found that the patients removed the plate after fracture healing, 23 patients had apparent atrophy of the PQ after repair, and prominent muscle scar and fibrosis. There was no difference in hand function between these 23 patients and other patients (29). Spies et al (30) have shown that patients with late tendon irritation after PQ repair persist, mainly where flexor pollicis longus rupture was caused by the plate being positioned too far, which may increase the risk of tendon injury.…”

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

“…They reported only 23 healed PQ with concomitant muscle atrophy in 126 patients after suturing, with the remaining patients showing scarring intraoperatively. Healing was assessed at implant removal by experienced surgeons [26]. The research group of Mulders et al investigated the question of functional differences between sutured and non-sutured PQ in a systematic review.…”