Skip to main content

Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial

Abstract

Introduction

Stable pronator quadratus repair following volar plate fixation of distal radius fractures with complete plate coverage is difficult.

Materials and methods

This study compares a modified pronator quadratus repair technique involving the brachioradialis muscle insertion (test group) with a conventional radial incision through the muscle without pronator quadratus repair (standard group). This prospective randomised study included 16 patients in the test group and 12 in the standard group; all were available for clinical, radiographic and ultrasound examination at a mean follow-up of 15 months.

Results

Pronator quadratus repair was feasible in all test group patients, and complete coverage of the distal plate was achieved in 11. No differences in functional outcome were observed between the groups.

Conclusion

Pronator quadratus repair with a part of the brachioradialis muscle insertion is a reliable technique for coverage of a volar plate by slight distal transposition. In the repair of distal radius fractures, this may better protect the finger flexor tendons against irritation and/or rupture. That likelihood should now be studied.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Unglaub F, Langer MF, Hohendorff B, Müller LP, Unglaub JM, Hahn P, Krimmer H, Spies CK (2017) Distal radius fracture of the adult: diagnostics and therapy. Orthopäde 46:93–110

    Article  PubMed  CAS  Google Scholar 

  2. Swigart CR, Baden MA, Bruegel VL, Dodds SD (2012) Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg Am 37:1868–1873

    Article  PubMed  Google Scholar 

  3. Abe Y (2014) Plate presetting and arthroscopic reduction technique (PART) for treatment of distal radius fractures. Handchir Mikrochir Plast Chir 46:278–285

    PubMed  CAS  Google Scholar 

  4. Dos Remedios C, Nebout J, Benlarbi H, Caremier E, Sam-Wing R (2009) Préservation du muscle carré pronateur dans les ostéosynthèses des fractures de l’extrémité distale du radius par plaque palmaire verrouillée. Technique chirurgicale. Chir Main 28:224–229

    Article  PubMed  CAS  Google Scholar 

  5. Erhard L, Boufarah C, Elkholti M (2007) Réparation du pronator quadratus par surjet aller-retour dans la voie de Henry. Rev Chir Orthop Reparatrice Appar Mot 93:381–384

    Article  PubMed  CAS  Google Scholar 

  6. Fan J, Chen K, Zhu H, Jiang B, Yuan F, Zhu X, Mei J, Yu G (2014) Effect of fixing distal radius fracture with volar locking volar plates while preserving pronator quadratus. Chin Med J (Engl) 127:2929–2933

    Google Scholar 

  7. Heidari N, Clement H, Kosuge D, Grechenig W, Tesch NP, Weinberg AM (2012) Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg Eur Vol 37:402–406

    Article  PubMed  CAS  Google Scholar 

  8. Hershman SH, Immerman I, Bechtel C, Lekic N, Paksima N, Egol KA (2013) The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma 27:130–133

    Article  PubMed  Google Scholar 

  9. Lo HY, Cheng HY (2014) Clinical study of the pronator quadratus muscle: anatomical features and feasibility of pronator-sparing surgery. BMC Musculoskelet Disord 15:136

    Article  PubMed  PubMed Central  Google Scholar 

  10. Rey PB, Rochet S, Loisel F, Obert L (2014) Technical note: how to spare the pronator quadratus during MIPO of distal radius fractures by using a mini-volar plate. Chir Main 33:95–99

    Article  PubMed  Google Scholar 

  11. Sen MK, Strauss N, Harvey EJ (2008) Minimally invasive plate osteosynthesis of distal radius fractures using a pronator sparing approach. Tech Hand Up Extrem Surg 12:2–6

    Article  PubMed  Google Scholar 

  12. Zenke Y, Sakai A, Oshige T, Moritani S, Fuse Y, Maehara T, Nakamura T (2011) Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma 25:425–431

    Article  PubMed  Google Scholar 

  13. Diwersi N, Babst R, Link BC (2016) Miniplates as augmentation implants in osteosynthesis of complex distal radius fractures. Oper Orthop Traumatol 28:402–406

    Article  PubMed  CAS  Google Scholar 

  14. Häberle S, Sandmann GH, Deiler S, Kraus TM, Fensky F, Torsiglieri T, Rondak IC, Biberthaler P, Stöckle U, Siebenlist S (2015) Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial. Eur J Med Res 20:93

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ries C, Maier J, Wegmann K, Zhang W, Hohendorff B, Skouras E, Müller LP, Burkhart KJ (2013) Anatomic relationship between the pronator quadratus and brachioradialis muscle insertion: implications for repair of the muscle after volar plate fixation of distal radius fractures. Z Orthop Unfall 151:272–277

    Article  PubMed  CAS  Google Scholar 

  16. Hohendorff B, Surberg D, Maier J, Burkhart KJ, Müller LP, Ries C (2015) Repair of the pronator quadratus muscle with a part of the brachioradialis muscle insertion. Handchir Mikrochir Plast Chir 47:149–154

    Article  PubMed  CAS  Google Scholar 

  17. Tang JB (2009) Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol 34:137–138

    Article  PubMed  Google Scholar 

  18. Pillukat T, Fuhrmann R, Windolf J et al (2016) The volar locking plate for extension fractures of the distal radius. Oper Orthop Traumatol 28:47–63

    Article  PubMed  CAS  Google Scholar 

  19. Orbay JL, Touhami A (2006) Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop Relat Res 445:58–67

    PubMed  Google Scholar 

  20. Soong M, Earp BE, Bishop G, Leung A, Blazar P (2011) Volar locking plate implant prominence and flexor tendon rupture. J Bone Jt Surg Am 93:328–335

    Article  Google Scholar 

  21. Asadollahi S, Keith PP (2013) Flexor tendon injuries following plate fixation of distal radius fractures: a systematic review of the literature. J Orthop Traumatol 14:227–234

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kitay A, Swanstrom M, Schreiber JJ, Carlson MG, Nguyen JT, Weiland AJ, Daluiski A (2013) Volar plate position and flexor tendon rupture following distal radius fracture fixation. J Hand Surg Am 38:1091–1096

    Article  PubMed  Google Scholar 

  23. Ahsan ZS, Yao J (2012) The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating. Hand (N Y) 7:276–280

    Article  Google Scholar 

  24. Huang HK, Wang JP, Chang MC (2017) Repair of pronator quadratus with partial muscle split and distal transfer for volar plating of distal radius fractures. J Hand Surg Am 42:935.e1–935.e5

    Article  Google Scholar 

  25. Ateschrang A, Stuby F, Werdin F, Schaller HE, Weise K, Albrechts D (2010) Flexor tendon irritations after locked plate fixation of the distal radius with the 3.5 mm T-plate: identification of risk factors. Z Orthop Unfall 148:319–325

    Article  PubMed  CAS  Google Scholar 

  26. Tosti R, Ilyas AM (2013) Prospective evaluation of pronator quadratus repair following volar plate fixation of distal radius fractures. J Hand Surg Am 38:1678–1684

    Article  PubMed  Google Scholar 

  27. Chirpaz-Cerbat JM, Ruatti S, Houillon C, Ionescu S (2011) Dorsally displaced distal radius fractures treated by fixed-angle volar plating: grip and pronosupination strength recovery. A prospective study. Orthop Traumatol Surg Res 97:465–470

    Article  PubMed  Google Scholar 

  28. Mulders MAM, Walenkamp MMJ, Bos FJME, Schep NWL, Goslings JC (2017) Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strateg Trauma Limb Reconstr 12:181–188

    Article  Google Scholar 

  29. Nho JH, Gong HS, Song CH, Wi SM, Lee YH, Baek GH (2014) Examination of the pronator quadratus muscle during hardware removal procedures after volar plating for distal radius fractures. Clin Orthop Surg 6:267–272

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sato K, Murakami K, Mimata Y, Doita M (2018) Incidence of tendon rupture following volar plate fixation of distal radius fractures: a survey of 2787 cases. J Orthop 15:236–238

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Christopher Ritter, PhD for assistance and preparation of the manuscript, Christiane Müller-Wiefel, MD and Peer Nekarda, MD for ultrasound examinations and Ulrike von Hehn for statistical analysis.

Funding

This research received no specific Grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bernd Hohendorff.

Ethics declarations

Conflict of interest

All the named authors hereby declare that they have no conflicts of interest to disclose.

Ethical approval

The study was approved by the ethics committee of the university of cologne and followed the most recent version of the Declaration of Helsinki.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hohendorff, B., Knappwerth, C., Franke, J. et al. Pronator quadratus repair with a part of the brachioradialis muscle insertion in volar plate fixation of distal radius fractures: a prospective randomised trial. Arch Orthop Trauma Surg 138, 1479–1485 (2018). https://doi.org/10.1007/s00402-018-2999-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-2999-5

Keywords

  • Distal radius
  • Fracture
  • Pronator quadratus
  • Volar locking plate
  • Repair