Flexor Tendon Rupture and Pronator Quadratus Repair Following Distal Radius Volar Plate Fixation
Abdo Bachoura, MD1; Vanessa Prokuski-Lund, MD2; David Zelouf, MD3; A Lee Osterman, MD4
1Philadelphia Hand Center, Rothman Orthopaedics, Lake Mary, FL; 2Philadelphia Hand to Shoulder Center, Philadelphia, PA; 3Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; 4The Philadelphia Hand Center, King of Prussia, PA
Introduction: Most studies that have evaluated the protective role of pronator quadratus (PQ) repair with respect to attritional tendon rupture have had relatively short follow-up durations which may not capture this often late complication. The purpose of this study is to evaluate the impact of PQ repair on attritional flexor tendon ruptures.
Methods: A total of 23 patients who underwent volar plate removal due to complete or partial flexor tendon rupture were analyzed. Patients were categorized into 2 groups: those whose PQ was repaired and those who did not have PQ repair at the time of ORIF. The 2 groups were compared for age at hardware removal, sex, hand dominance, Soong classification, volar tilt, and the time interval from fixation until complete flexor tendon rupture. Continuous data were compared using an unpaired t-test and the Mann-Whitney nonparametric test. Categorical data were analyzed using the Fisher exact test. Power analysis revealed that 34 patients were required in each group to detect differences in means between 2 independent groups, with statistical power set at 0.80, an alpha error probability of 0.05 and a large effect size of 0.7.
Results: The mean interval from operative fixation until complete tendon rupture was 3.84 years, (range, 0.7-13.1 years) (n=12). No statistically significant differences between the 2 groups were found in terms of sex, age at hardware removal, dominant side affected, Soong grade and volar tilt. The mean duration from ORIF until complete tendon rupture was 4.88 years for patients that underwent PQ repair and 2.37 years for those that did not, p=0.11 (Table 1).
Conclusions: The findings of this study confirm previous studies suggesting that PQ repair does not prevent flexor tendon rupture. However, in this study the duration to flexor tendon rupture was longer in the group that underwent PQ repair (4.88 years vs. 2.37 years). Although these results did not reach statistical significance, possibly due to the study being underpowered, further investigation is recommended into the PQ acting as a protective barrier that can delay flexor tendon attritional injury in patients with prominent volar plates. In addition, a poor reduction and high Soong index may be the key indicators of potential rupture.
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