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Pronator quadratus preserving versus pronator quadratus dissecting approaches in volar plate fixation of distal radius fractures: a systematic review of comparative studies

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Abstract

Purpose

To compare pronator quadratus preserving (PQ-P) approaches with PQ dissecting (PQ-D) approaches in volar plate fixation of distal radius fractures (DRFs).

Methods

Three databases were searched on March 10th, 2024. The authors adhered to the PRISMA and R-AMSTAR guidelines and Cochrane Handbook for Systematic Reviews. Data on demographics, fracture classifications, patient reported outcome measures (PROMs), range of motion, radiographic parameters, and complications were extracted.

Results

Thirteen studies with a total of 1007 fractures were included. Two of three studies reported lower DASH scores in the PQ-P group between 6 weeks and 3 months postoperative, however no studies reported lower scores in the PQ-P group after 3 months. Three of three studies reported significantly lower VAS scores at 6 weeks postoperative, however no studies reported significant differences after 6 months. Only one of six studies reported significantly greater flexion, extension, and pronation in the PQ-P group. One of four studies reported greater radial deviation in the PQ-P group, while there were no differences in supination or ulnar deviation. One of ten and one of six studies reported greater volar tilt and ulnar variance or radial length, respectively, in the PQ-P group.

Conclusion

There is not sufficient evidence supporting the utility of PQ-P approaches over conventional PQ-D approaches for volar plate fixation of DRFs, especially at long-term follow-ups (3+ months). There may be short term benefits with PQ-P approaches, specifically with regards to PROMs in the short-term (< 6 weeks), however there is limited high-quality evidence supporting these findings.

Level of evidence

Level III.

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References

  1. Gordon KD, Dunning CE, Johnson JA, King GJW (2003) Influence of the pronator quadratus and supinator muscle load on DRUJ stability. J Hand Surg 28:943–950. https://doi.org/10.1016/s0363-5023(03)00487-8

    Article  Google Scholar 

  2. Orbay JL, Touhami A (2006) Current concepts in volar fixed-angle fixation of unstable distal radius fractures. Clin Orthop 445:58–67. https://doi.org/10.1097/01.blo.0000205891.96575.0f

    Article  PubMed  Google Scholar 

  3. Tordjman D, Hinds RM, Ayalon O et al (2016) Volar-ulnar approach for fixation of the volar lunate facet fragment in distal radius fractures: a technical tip. J Hand Surg 41:e491–e500. https://doi.org/10.1016/j.jhsa.2016.09.007

    Article  Google Scholar 

  4. Walch A, Erhard L, Vogels J et al (2019) Ultrasound evaluation of the protector role of the pronator quadratus suture in volar plating. J Ultrasound Med 38:2785–2791. https://doi.org/10.1002/jum.14968

    Article  PubMed  Google Scholar 

  5. Mulders MAM, Walenkamp MMJ, Bos FJME et al (2017) Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strateg Trauma Limb Reconstr 12:181–188. https://doi.org/10.1007/s11751-017-0288-4

    Article  Google Scholar 

  6. Heidari N, Clement H, Kosuge D et al (2012) Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg Eur 37:402–406. https://doi.org/10.1177/1753193411424706

    Article  CAS  Google Scholar 

  7. Armangil M, Bezirgan U, Başarır K et al (2014) The pronator quadratus muscle after plating of distal radius fractures: is the muscle still working? Eur J Orthop Surg Traumatol Orthop Traumatol 24:335–339. https://doi.org/10.1007/s00590-013-1193-2

    Article  Google Scholar 

  8. Goorens CK, Debaenst N, Van Royen K et al (2022) Minimally invasive pronator quadratus sparing approach versus extended flexor carpi radialis approach with pronator quadratus repair for volar plating in distal radial fractures. J Wrist Surg 11:41–47. https://doi.org/10.1055/s-0041-1731329

    Article  PubMed  Google Scholar 

  9. Itoh M, Itou J, Okazaki K, Iwasaki K (2023) Estimation failure risk by 05-mm differences in autologous hamstring graft diameter in anterior cruciate ligament reconstruction: a meta-analysis. Am J Sports Med 52(2):535–543. https://doi.org/10.1177/03635465221150654

    Article  PubMed  Google Scholar 

  10. Kung J, Chiappelli F, Cajulis OO et al (2010) From systematic reviews to clinical recommendations for evidence-based health care: validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J 4:84–91. https://doi.org/10.2174/1874210601004020084

    Article  PubMed  PubMed Central  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700. https://doi.org/10.1136/bmj.b2700

    Article  PubMed  PubMed Central  Google Scholar 

  12. McHugh ML (2012) Interrater reliability: the kappa statistic. Biochem Medica 22:276–282

    Article  Google Scholar 

  13. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73:712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x

    Article  PubMed  Google Scholar 

  14. Vivekanantha P, Nedaie S, Grzela P et al (2023) Though five-strand hamstring autografts demonstrate greater graft diameter, postoperative outcomes are equivocal to four-strand hamstring autograft preparations: a systematic review and meta-analysis of level I and II studies. Knee Surg Sports Traumatol Arthrosc 31(10):4437–4447. https://doi.org/10.1007/s00167-023-07515-8

    Article  PubMed  Google Scholar 

  15. Detsky AS, Naylor CD, O’Rourke K et al (1992) Incorporating variations in the quality of individual randomized trials into meta-analysis. J Clin Epidemiol 45:255–265. https://doi.org/10.1016/0895-4356(92)90085-2

    Article  CAS  PubMed  Google Scholar 

  16. Kennedy CA, Beaton DE, Smith P et al (2013) Measurement properties of the QuickDASH (disabilities of the arm, shoulder and hand) outcome measure and cross-cultural adaptations of the QuickDASH: a systematic review. Qual Life Res 22:2509–2547. https://doi.org/10.1007/s11136-013-0362-4

    Article  PubMed  Google Scholar 

  17. Gummesson C, Atroshi I, Ekdahl C (2003) The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskelet Disord 4:11. https://doi.org/10.1186/1471-2474-4-11

    Article  PubMed  PubMed Central  Google Scholar 

  18. Langley GB, Sheppeard H (1985) The visual analogue scale: its use in pain measurement. Rheumatol Int 5:145–148. https://doi.org/10.1007/BF00541514

    Article  CAS  PubMed  Google Scholar 

  19. Zhang X, Huang X, Shao X et al (2017) A comparison of minimally invasive approach vs conventional approach for volar plating of distal radial fractures. Acta Orthop Traumatol Turc 51:110–117. https://doi.org/10.1016/j.aott.2017.02.013

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zenke Y, Sakai A, Oshige T et al (2011) Clinical results of volar locking plate for distal radius fractures: conventional versus minimally invasive plate osteosynthesis. J Orthop Trauma 25:425–431. https://doi.org/10.1097/BOT.0b013e3182008c83

    Article  PubMed  Google Scholar 

  21. Huang X, Jia Q, Li H et al (2022) Evaluation of sparing the pronator quadratus for volar plating of distal radius fractures: a retrospective clinical study. BMC Musculoskelet Disord 23:625. https://doi.org/10.1186/s12891-022-05576-3

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lee SK, Ma SB, Kim W, Choy WS (2021) A comparison of pronator quadratus preservation and dissection approaches for volar plating of comminuted intra-articular distal radius fracture. Ann Plast Surg 86:412–420. https://doi.org/10.1097/SAP.0000000000002713

    Article  CAS  PubMed  Google Scholar 

  23. Huang X, Wu B, Hamiti Y et al (2023) Evaluation of the treatment of distal radial volar fracture by different methods sparing the pronator quadratus. J Orthop Surg 18:722. https://doi.org/10.1186/s13018-023-04184-8

    Article  Google Scholar 

  24. Pire E, Hidalgo Diaz JJ, Salazar Botero S et al (2017) Long volar plating for metadiaphyseal fractures of distal radius: study comparing minimally invasive plate osteosynthesis versus conventional approach. J Wrist Surg 6:227–234. https://doi.org/10.1055/s-0037-1599791

    Article  PubMed  PubMed Central  Google Scholar 

  25. Thalhammer G, Hruby LA, Dangl T et al (2023) Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial. J Orthop Traumatol 24:16. https://doi.org/10.1186/s10195-023-00700-y

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fan J, Jiang B, Wang B et al (2016) Analysis of soft-tissue complications of volar plate fixation for managing distal radius fractures and clinical effect while preserving pronator quadratus. Acta Orthop Belg 82:305–312

    CAS  PubMed  Google Scholar 

  27. Fan J, Zhang X, Ji J-Q et al (2021) Fixation of distal radius fracture with volar locking palmar plates while preserving pronator quadratus through the minimally invasive approach. Technol Health Care 29:167–174. https://doi.org/10.3233/THC-192113

    Article  PubMed  Google Scholar 

  28. Itoh S, Yumoto M, Kanai M et al (2016) Significance of a pronator quadratus-sparing approach for volar locking plate fixation of comminuted intra-articular fractures of the distal radius. Hand NY 11:83–87. https://doi.org/10.1177/1558944715617460

    Article  Google Scholar 

  29. Cannon TA, Carlston CV, Stevanovic MV, Ghiassi AD (2014) Pronator-sparing technique for volar plating of distal radius fractures. J Hand Surg 39:2506–2511. https://doi.org/10.1016/j.jhsa.2014.09.011

    Article  Google Scholar 

  30. Chen C-Y, Lin K-C, Yang S-W et al (2015) Clinical results of using minimally invasive long plate osteosynthesis versus conventional approach for extensive comminuted metadiaphyseal fractures of the radius. Arch Orthop Trauma Surg 135:361–367. https://doi.org/10.1007/s00402-015-2162-5

    Article  PubMed  Google Scholar 

  31. Kapoor H, Agarwal A, Dhaon BK (2000) Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reduction with internal fixation. Injury 31:75–79. https://doi.org/10.1016/s0020-1383(99)00207-7

    Article  CAS  PubMed  Google Scholar 

  32. Kreder HJ, Hanel DP, Agel J et al (2005) Indirect reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular fractures of the distal radius: a randomised, controlled trial. J Bone Jt Surg Br 87:829–836. https://doi.org/10.1302/0301-620X.87B6.15539

    Article  CAS  Google Scholar 

  33. Häberle S, Sandmann GH, Deiler S et al (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. https://doi.org/10.1186/s40001-015-0187-4

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hinds RM, Montero-Lopez N, Brock K et al (2020) Assessment of pronator quadratus repair integrity using dynamic ultrasonography following volar plate fixation for distal radius fractures. Hand NY 15:111–115. https://doi.org/10.1177/1558944718787327

    Article  Google Scholar 

  35. Sonntag J, Hern J, Woythal L et al (2021) The pronator quadratus muscle after volar plating: ultrasound evaluation of anatomical changes correlated to patient-reported clinical outcome. Hand NY 16:32–37. https://doi.org/10.1177/1558944719840737

    Article  Google Scholar 

  36. Turley LP, Hurley ET, White-Gibson A et al (2023) Pronator quadratus repair after volar plating for distal radius fractures: a systematic review and meta-analysis of randomized controlled trials. Acta Orthop Traumatol Turc 57:176–182. https://doi.org/10.5152/j.aott.2023.22154

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mann FA, Wilson AJ, Gilula LA (1992) Radiographic evaluation of the wrist: what does the hand surgeon want to know? Radiology 184:15–24. https://doi.org/10.1148/radiology.184.1.1609073

    Article  CAS  PubMed  Google Scholar 

  38. Steyers CM, Blair WF (1989) Measuring ulnar variance: a comparison of techniques. J Hand Surg 14:607–612. https://doi.org/10.1016/0363-5023(89)90175-5

    Article  CAS  Google Scholar 

  39. Adams BD (1993) Effects of radial deformity on distal radioulnar joint mechanics. J Hand Surg 18:492–498. https://doi.org/10.1016/0363-5023(93)90098-N

    Article  CAS  Google Scholar 

  40. Altissimi M, Antenucci R, Fiacca C, Mancini GB (1986) Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop 206:202–210

    Article  Google Scholar 

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Funding

There were no funds, grants, or other support was received for the submitted work. The authors have no financial or proprietary interests in any material discussed in this manuscript.

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Authors and Affiliations

  1. Michael DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada

    Prushoth Vivekanantha

  2. Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Jack Soeder, Colin Kruse, Hassaan Abdel Khalik & Asher Selznick

  3. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Tyler McKechnie & Herman Johal

  4. Section of Orthopedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada

    Herman Johal

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  1. Prushoth Vivekanantha
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Correspondence to Prushoth Vivekanantha.

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Vivekanantha, P., Soeder, J., Kruse, C. et al. Pronator quadratus preserving versus pronator quadratus dissecting approaches in volar plate fixation of distal radius fractures: a systematic review of comparative studies. Eur J Orthop Surg Traumatol (2024). https://doi.org/10.1007/s00590-024-03967-x

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