Do we really need to repair the pronator quadratus after distal radius plating?

Abstract

PurposeFractures of distal radius are one of the common orthopaedic injuries. Placing the plate on volar surface requires release of underlying pronator quadratus (PQ) muscle. No consensus is present in the literature about the repair or not of the PQ. The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.MethodsRetrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated. Demographic data, operative notes and physical therapy records were retrieved. Patients were divided into group A where PQ repair was done and group B where no repair was done. Functional data such as range of motion (ROM), grip strength, visual analogue scale (VAS) score and disabilities of arm, shoulder and hand (DASH) score at 4 weeks, 3 months, 6 months and finial follow-up were retrieved.ResultsTotally 63 patients (n = 29 in group A and n = 34 in group B) with the mean age of 51.64 years were examined. Patients were followed up for a mean of 35.2 months (range 27.2–47.1 months) in group A and 38.6 months (range 28.6–51.0 months) in group B. Though functional outcome of the affected limb was not significantly different between two groups after 3 months, PQ repair did affect the recovery at an early stage. Repair group had significantly better ROM (p = 0.0383) and VAS score at 4 weeks (p = 0.017) while grip strength (p = 0.014) was significantly better at 3 months.ConclusionsRepair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.

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

“…We excluded two studies from the Cochrane Central Register of Controlled Trials database, one master's thesis, which is a review article from the CNKI database, and one RCT that compared PQ repair with no PQ repair with only 3 months of follow-up. Therefore, the meta-analysis included five RCTs [8,10,[18][19][20] and six retrospective case-control studies [7,[21][22][23][24][25].…”

“…Most studies presented the number of fractures in each AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification [26], except one study [23] that did not report the included fracture types. Two studies analyzed the outcomes of patients with DRF AO/OTA types B and C [22,25] with or without PQ repair instead of the pooled outcomes.…”

Impact of Pronator Quadratus Muscle Tear in Distal Radius Fractures on Patient Outcomes: Analyses of 55 Patients in a Volar Locking Plate Arm of a Randomized Clinical Trial

“…Some authors claim that patients experience an early effect of PQ repair. In a retrospective study of 63 patients, Pathak et al reported improved pain relief and ROM at four weeks, and improved grip strength at three months in the repair group [ 21 ]. We could not confirm these early findings in our study.…”

Pronator quadratus repair after volar plating for distal radius fractures: A systematic review and meta-analysis of randomized controlled trials

“…Furthermore, it may be more important to consider the Soong index in accurate plate positioning as this has been shown to correlate to the rate of plate removal and tendon damage. 12 - 14 Additionally, Parthak et al 15 found in the early postoperative period that PQ repair may result in reduced pain levels which may be from protecting these tendons in the early postoperative period. Overall, RCTs may not be appropriate to assess the potential benefit of plate coverage as they may be drastically underpowered to assess this uncommon but clinically important complication, large-scale population-based studies thus may be more appropriate.…”