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Pronator Quadratus Rotational Muscle Flap to Limit Flexor Tendon Injury from VDR Plate Fixation
Deana Mercer, MD; Dustin Larson, MD; Cole Paffett, BS; Joshua Romero, BS; Leslie Neher, BS; Christina Salas, PhD
University of New Mexico, Albuquerque, NM
Introduction: Flexor tendon rupture is a recognized complication following volar distal radius (VDR) plate fixation. Restoration of the pronator quadratus (PQ) has been shown to protect the overlying tendons, but the plate may limit the ability to restore the PQ to its native position. A PQ rotational muscle flap may allow for increased excursion to cover the distal aspect of a VDR plate to minimize the risk of flexor tendon rupture.
Materials & Methods: 13 cadaveric hands with forearms were used. A fellowship trained hand surgeon exposed the PQ and marked it at 25%, 50%, and 75% of its total length along the ulnar border. The muscle was then raised off the volar aspect of the distal radius. A VDR plate was placed on the bone and held in place with a single screw positioned in the oblong hole along its shaft. The PQ was repositioned over the plate and photographed to document its initial plate coverage area. (Fig.1) Sequential cuts were made to the PQ proximally, ulnar and volar to the anterior interosseous branch of the median nerve at the 25%, 50%, and 75% marks. The PQ was repositioned over the plate after each cut and the specimen was photographed to document new coverage area. (Fig.2) Care was taken to optimize distal plate coverage. ImageJ software was used to quantify the exposed plate area (total, distal only, proximal only) after coverage by the intact and sequentially sectioned PQ for each specimen. The primary outcome measure was the percent increase of plate coverage from intact PQ to 25%, 50%, and 75% sectioned specimens, respectively. Results are presented as % increase in coverage of the distal aspect of the volar plate (DVP) and % increase in coverage of the proximal aspect of the volar plate (PVP).
Results: A 25% cut of the proximal aspect of the PQ resulted in an increase in coverage of 54.3+/-0.2% of the DVP and 34.3+/-0.5% of the PVP. A 50% cut increased coverage to 64.7+/-0.2% of the DVP and 42.5+/-0.7% of the PVP. A 75% cut increased coverage to 82.0+/-0.2% of the DVP, but decreased coverage to 11.1+/-0.9% of the PVP.
Conclusion: A PQ rotational muscle flap allows for increased excursion to cover the distal aspect of a VDR plate proportional to the percentage of the PQ cut proximally. This technique may limit the occurrence of flexor tendon injury following VDR plate fixation.  |  |
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