gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Loading the pronator quadratus improves distal radio-ulnar joint stability in the setting of an ulnar styloid fracture

Meeting Abstract

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  • presenting/speaker Mauro Maniglio - Inselspital Bern, University Hospital, Bern, Switzerland
  • Il Jung Park - Tibor Rubin VA Medical Center, Long Beach, United States
  • Victor Truong - Tibor Rubin VA Medical Center, Long Beach, United States
  • Remy Flueckiger - Inselspital Bern, University Hospital, Bern, Switzerland
  • David Wright - Tibor Rubin VA Medical Center, Depart of Orthopaedic Surgery, Univ of CA, Irvine, Long Beach, United States
  • Michael Kuenzler - Inselspital Bern, University Hospital, Bern, Switzerland
  • Lilianna Bollinger - Inselspital Bern, University Hospital, Bern, Switzerland
  • Matthias Zumstein - Inselspital Bern, University Hospital, Bern, Switzerland
  • Michelle McGarry - Tibor Rubin VA Medical Center, Congress Medical Foundation, Pasadena, CA, Long Beach, United States
  • Thay Lee - Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, Long Beach, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1451

doi: 10.3205/19ifssh1285, urn:nbn:de:0183-19ifssh12853

Veröffentlicht: 6. Februar 2020

© 2020 Maniglio et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objectives/Interrogation: With a volar approach to repair distal radius fractures (DRF) the pronator quadratus (PQ) is often violated. The merits of repairing the PQ to restore pronation strength, protect flexor tendons and increase distal radioulnar joint (DRUJ) stability remain controversial. Several studies reported no change in clinical outcome due to PQ repair. DRFs are often associated with ulnar styloid fractures (USF), which have been shown to lead to a significant loss of DRUJ stability when the styloid fractures involve the fovea. The PQ may be key in reducing postoperative DRUJ instability in a DRF with a USF involving the fovea. Therefore the objective of this study was to quantify the effects of PQ loading on DRUJ stability in a cadaveric model of USF.

Methods: Soft tissue was carefully removed from 17 forearm specimens (7 male, 10 female; mean age 64.5; range 56-77), leaving the interosseous membrane, extensor carpi ulnaris (ECU), pronator quadratus (PQ), and triangular fibrocartilage complex. Forearms were mounted on a custom testing system and the ECU was loaded with 5N. A USF including the ulnar fovea was performed. Pronosupination was measured with 1Nm of torque and dorso-palmar (DP) translation was measured using 15N of load. DP-translation was measured in neutral, full pronation and 90° supination. Measurements were repeated with loading the PQ with 0N; 2.5N; and 5N.

Results and Conclusions: In full pronation with a 5N load, DP-translation decreased significantly compared to 2.5N (p<0.006) and 0N (p<0.001) loads. Significant decreases were also found in neutral with a 5N load compared to the 2.5N (p<0.001) and 0N (p<0.001) loads. Total pronosupination decreased significantly from 0N to 5N (p<0.001), changing on average from 206° to 203°.

Loading the pronator quadratus significantly decreased translation and rotation of the DRUJ. Even though the amount of change in stability was small repair of the pronator quadratus may be warranted if there are concerns about residual DRUJ instability.