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

Abstract

Background The conventional volar approach requires the release of the pronator quadratus (PQ) muscle in the treatment of distal radius fractures. However, releasing PQ muscle could cause loss of function and a host of complications.Aim This study compared the outcomes of different methods of sparing the PQ muscle combined with volar plate in the treatment of distal radius fractures.Methods A total of 68 patients with distal radius fractures were enrolled with either the brachioradialis (BR) splitting approach (Group A,33 people) or through the tunnel behind the PQ muscle approach (Group B,35 people). Postoperative internal fixation, fracture healing and postoperative complications were observed in the two groups. The visual analog scale (VAS) of postoperative wrist pain was compared between the two groups. The Dienst joint scale was used to evaluate the wrist function of patients, and imaging indexes were used to evaluate the surgical efficacy.Results A total of 68 patients with distal radius fractures were followed up for more than 1 year after surgery. All fractures obtained good union, with no vascular injury, nerve injury, or wound infection. There was no significant difference in the baseline characteristics of both groups. Outcomes at 3 days,1 month,and 3 months all showed no significant differences in postoperative imaging indexes between the two groups. There were significant differences in the mean operative time between the two groups. Nevertheless, no significant differences were shown in mean operative blood loss and mean bone union time between the two groups. There was no significant difference in the results of complications between the two groups. No significant differences in limb function scores, VAS scores and the mean range of motion existed the two groups at the 12-month postoperative follow-up. However, outcomes assessed at 1 week, 1 month, and 3 months after surgery demonstrated significant differences in the VAS scores and the mean range of motion between the two groups.Conclusion Our results demonstrated that these two different surgical approaches were effective ways to reserve PQ and had good clinical outcomes. Placing the plate under the quadratus muscle could reduce early postoperative pain, promote early activity, and returned to normal life. The BR splitting approach was more advantageous in intraoperative fracture exposure and could shorten the operative time. However, some defects also existed. Therefore, surgeons should be aware of their individual characteristics and chose patients carefully.