Results of pronator quadratus repair in distal radius fractures to prevent tendon ruptures

Mohammad Ali Tahririan, Mohammad Javdan, Mehdi Motififard, Mohammad Ali Tahririan, Mohammad Javdan, Mehdi Motififard

Abstract

Background: Distal radius fractures are one of the the most common adult fractures encountered during the clinical practice of an orthopedic surgeon.12 Although several methods of treatment are suggested for these fractures, there are still controversies about the best treatment approach in the literature. Volar plating of distal radius fracture is a method of treatment which has become increasingly popular. One of the complications of this technique is flexor tendon rupture. The purpose of this study was to evaluate the protectiveness of complete repair of pronator quadratus muscle against flexor tendon rupture.

Materials and methods: From September 2010 to September 2012, a consecutive series of 157 patients who were younger than 60 years with unstable distal radius fractures were included in the study. A standard volar approach to the distal radius was carried out. The radial and distal ends of pronator quadratus muscle were meticulously elevated from the radius and after volar plate fixation of the fracture, pronator quadratus muscle was restored to its normal insertion. We achieved full coverage of the plate with this muscle and followed the patients postoperatively.

Results: A total of 135 patients were studied. The mean age of patients was 34 ± 10 years (range 20-60 years). One 55-year-old diabetic female patient with flexor tendon rupture was identified. The flexor pollicis longus tendon had ruptured 16 months after surgery.

Conclusions: Pronator quadratus repair should be done in distal radius fracture to protect flexor tendons.

Keywords: Distal radius fracture; Radius fracture; flexor tendon rupture; implants; pronator quadratus; rupture; tendon injuries; volar plate.

Conflict of interest statement

Conflict of Interest: No benefits in any form have been received or will be received directly or indirectly to the subject of this article

Figures

Figure 1
Figure 1
Summary of methodology for selecting patients
Figure 2A
Figure 2A
Peroperative clinical photographs showing (a) exposure of PQ muscle (b) Detachment of PQ muscle with a rim of brachioradialis tendon (c) Detachment of PQ from distal insertion
Figure 2B
Figure 2B
Peroperative clinical photograph showing (a) placement of volar plate (b) Reattachment of radial border of PQ to brachioradialis (c) Complete coverage of the plate at the radial side (d) Reattachment of PQ distal to a rim of volar capsule
Figure 3
Figure 3
Radiograph of wrist with forearm anteroposterior (a) and lateral (b) views showing fracture has united and implantin situ

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