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

Abstract

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.

The Outcome of under 10 mm Single-Incision Surgery Using a Non-Specialized Volar Plate in Distal Radius Fractures: A Retrospective Comparative Study

“…Given that the pronator quadratus functions as a secondary forearm pronator and dynamically stabilizes the distal radioulnar joint, and an intact pronator quadratus can serve as a biological barrier for the flexor tendons, the question of whether the integrity or repair of the pronator quadratus contributes to clinical outcomes is a frequently debated topic [22][23][24]. Despite diverse perspectives in the literature [25][26][27][28], current high-level evidence suggests that the integrity or repair of the pronator quadratus does not definitively impact clinical results [22][23][24]29]. In our clinical practice, displaced fractures of the distal radius often coincide with a partial tear of the pronator quadratus.…”

Current Management and Volar Locking Plate Fixation with Bone Cement Augmentation for Elderly Distal Radius Fractures—An Updated Narrative Review

“…Nguyen et al found that a hand strength-focused exercise program for elderly DRFs non-surgically managed with CI while significantly immobilized improves grip strength [76]. VLPF involving dissecting the pronator quadratus significantly lowers range of motion and pronation strength [77], so post-surgical rehabilitation might be beneficial. Nonetheless, Gamo et al found that hand therapies improve the outcomes after VLPF for DRFs in middle-aged to elderly women at 8 weeks but not at 6 months after surgery [78].…”