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Prospective Randomized Repair of the Pronator Quadratus Following Volar Plate Fixation of Distal Radius Fractures
Rick Tosti1; Asif M. Ilyas, MD2
1Orthopaedic Surgery and Sports Medicine, Temple University, Philadelphia, PA; 2Rothman Institute, Thomas Jefferson University, Philadelphia, PA

INTRODUCTION: Volar plate fixation of distal radius fractures is becoming more common. Application of the plate requires exposure and elevation of the pronator quadratus (PQ). Repair of the PQ following plate fixation has been purported to improve wrist motion, grip strength, and prevent against iatrogenic flexor tendon injury. To better understand the value of repairing the PQ a prospective randomized trial was undertaken with the null hypothesis being that repair of the PQ will result in no clinical difference.

METHODS: From January 2011 to December 2011, all consecutive distal radius fractures treated operatively with a volar plate were randomized to either repair of the PQ or not, upon closure following fixation of the plate. Surgical exposure, reduction, and the post-operative rehabilitation were similar in both groups. Clinical outcomes with a minimum follow-up of 12 months were compared between each group including motion; grip strength; DASH scores; and VAS scores.

RESULTS: Sixty consecutive distal radius fractures were treated operatively with a locking volar plate. Two patients were lost to follow-up, and one was excluded for an ipsilateral elbow fracture-dislocation. Full follow up data was available for 33 patients in the PQ Repair group and 24 patients in the control group. The mean DASH score was 7.78 for the repair group and 4.86 for the control group (p = 0.28). VAS in the repair group averaged 0.35 in the repair group and 0.18 for the control group (p =0.37). Range of motion assessed in flexion, extension, supination, pronation, radial deviation, and ulnar deviation was also not significantly different between groups. Additionally, no significant differences were found in any of the parameters at the 2,6, or 12-week intervals except a greater grip strength and flexion was observed in the repair group at 6 weeks. Reoperation was required in 4 patients in the repair group (3 carpal tunnel release, 1 removal of hardware for extensor tenosynovitis) and in 1 patient in the control group (1 removal of hardware for extensor tenosynovitis).

SUMMARY: In this prospective randomized study, PQ repair was not found to significantly improve range of motion, grip strength, or DASH and VAS scores. The rate of reoperation between groups were also not significantly different. We cannot recommend routine repair of the PQ following volar plate fixation of distal radius fractures.

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