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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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Volar Plating of Distal Radius Fractures: Comparison of the Functional Outcomes of the Pronator Quadratus Muscle Repair, Non-repair, and Preserving Techniques

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  • Ja Hea Gu - Dankook University, Cheonan, South Korea
  • presenting/speaker Jong-Pil Kim - Dankook University, Cheonan, South Korea
  • Jae-Uk Jung - Dankook University, Cheonan, South Korea

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. DocIFSSH19-955

doi: 10.3205/19ifssh0686, urn:nbn:de:0183-19ifssh06864

Published: February 6, 2020

© 2020 Gu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: To demonstrate how the pronator quadratus (PQ) muscle function is affected in terms of forearm pronation after volar plating of distal radius fracture with PQ preservation and whether clinical outcomes would be affected by any pronation strength decrease compared to conventional technique.

Methods: A randomized controlled prospective study was performed by gathering data from all sixty-six patients treated with volar locking plate fixation for distal radius fractures divided into three groups: Group 1 with PQ preserving, Group 2 with PQ repair after splitting, and Group 3 with PQ non-repair after splitting. Clinical outcome measurement included the visual analogue scale (VAS), the disability of the arm, shoulder and hand (DASH) score, the patient-rated wrist evaluation (PRWE) score, range of wrist motion, grip strength at 12, 24, 48weeks after surgery, and the isokinetic force of forearm pronation strength at 48 weeks after surgery. Radial height, radial inclination, ulnar variance, and palmar tilt were measured on wrist radiographs which takes immediately after surgery and at last follow-up for the radiologic outcomes.

Results and Conclusions: At 12 weeks after surgery, the average grip strength was 34.5±18.43N in group 1, 45.5±21.57N in group 2, and 31.91±15.4N in group 3.(P=0.043) At 24 weeks after surgery, the average extension was 71.32±11.94º in group 1, 79.91±8.37º in group 2, 73.05±12.56º in group 3. (P=0.031) Radial deviation was 19.55±4.21º in group 1, 22.91±6.49º in group 2, 17.95±5.46º in group 3. (P=0.012) Ulnar deviation was 26.55±6.1º in group 1, 31.14±4.86 in group 2, 27.36±6.97 in group 3. (P=0.033) The average grip strength was 42.23±21.62N in group 1, 60.23±23.68 in group 2, 47.45±21.97 in group 3. (P=0.029) At 48 weeks follow up, the average PRWE score was 16.82±23.06 in group 1, 11.68±14.90 in group 2, 31.77±30.49 in group 3. (P=0.018) Radiologic parameters were no statistically difference among the three groups. There were no complications such as complex regional pain syndrome(CRPS), post-traumatic arthritis, malunion, nonunion, delayed union, and reduction loss.

PQ preservation with volar plating in distal radius fracture does not have benefit of forearm pronation strength, clinical and radiologic outcomes. Instead of preservation, pronator quadratus muscle repair is suggested when volar plate fixation is done in distal radius fractures.