ABSTRACT
Objective: To investigate the effectiveness of pronator quadratus muscle sparing in volar plate fixation for unstable distal radius fracture in adults. Methods: The clinical data of 62 cases of unstable distal radius fractures between January 2017 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative exposure, the patients were divided into the observe group (28 cases with the pronator quadratus muscle sparing surgery) and the control group (32 cases with cutting the pronator quadratus muscle in operation and repairing it after volar plate fixation). There was no significant difference in general data such as gender, age, handedness, cause of injury, fracture classification, time from injury to operation, visual analogue scale (VAS) score, and range of motion (ROM) of wrist (flexion, extension, pronation, and supination) before operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, fracture healing time, and postoperative complications were recorded and compared between the two groups. VAS score and ROM of wrist of two groups before operation and at 3 days and 3 months after operation were calculated and compared. The wrist function was evaluated according to the Krimmer evaluation criteria at 6 months after operation. Results: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). The postoperative hospital stay and fracture healing time of the observe group were significantly shorter than those of the control group ( P0.05). At 6 months after operation, according to Krimmer evaluation criteria, the wrist function of the observe group was excellent in 21 cases and good in 7 cases, with an excellent and good rate of 100%; and the wrist function of the control group was excellent in 22 cases, good in 11 cases, and fair in 1 case, with an excellent and good rate of 97.1%. There was no significant difference in wrist function between the two groups ( χ2=1.344, P=0.511). One case of poor incision healing occurred in the observe group, and 7 cases of poor incision healing and 5 cases of tendon pain occurred in the control group after operation. The incidence of postoperative complications was less in the observe group (3.6%) than in the control group (35.3%) ( χ2=9.325, P=0.002). Conclusion: It is feasible of the pronator quadratus muscle sparing in the volar plate fixation for unstable distal radius fracture in adults. It is beneficial to recover wrist function early after operation, reduce postoperative complications, shorten the length of hospitalization, protect the soft tissue of fracture site, and promote fracture healing.
ABSTRACT
PURPOSE: The purpose of this study is to evaluate the pronator quadrates muscle in patients who underwent internal fixation with a volar locking plate for unstable distal radius fractures. MATERIALS AND METHODS: Forty patients who underwent internal fixation with a volar locking plate for unstable distal radius fracture were enrolled. We evaluated the clinical results according to the Mayo wrist score, the wrist range of motion, and the grip strength at the last follow-up. Using ultrasonography, muscle thickness of the pronator quadrates was compared between injured and uninjured arm. RESULTS: Bone union was achieved in all cases. The mean Mayo wrist score was 82.79 points. The grip strength of the injured arm was decreased to 89.1% of the uninjured side. The decrease of pronation range of the injured wrist motions was significant (82.3degrees, p=0.004). There was significant atrophy of the pronator quadrates muscle on the injured side (injured side: 3.19 mm, uninjured side: 4.72 mm, p=0.001); and the decrement of muscle thickness in pronator quadrates showed an association with the Mayo wrist score (r=-0.35, p=0.042). CONCLUSION: These results suggest that continuity of the muscle is maintained after use of the volar locking plating for unstable distal radius fractures with repair of pronator quadrates; however, there is atrophy of pronator quadrates muscle and limitation of pronation in the injured wrist.
Subject(s)
Humans , Arm , Atrophy , Follow-Up Studies , Hand Strength , Pronation , Radius Fractures , Range of Motion, Articular , Ultrasonography , WristABSTRACT
PURPOSE: To collect data regarding the pronator-sparing approach using an anatomical study, which compared the fractures of the distal radius and pronator quadratus (PQ) muscle of an adult cadaveric radius. MATERIALS AND METHODS: Fourteen adult cadaver wrists that did not have previous fractures or previous surgery and computed tomography data 32 fractures of the distal radius, were obtained. The size of the distal fracture fragment was measured using the picture archiving and communication system. The distance between the distal margin of the PQ muscles and the articular margin was measured using a caliper. RESULTS: The PQ muscles had an average distance of 10.9 mm (range, 8-13 mm) from the radial styloid process and 10 mm (range, 8-12 mm) from the distal radioulnar joint (DRUJ). The fracture sites were located an average of 21.8 mm (range, 10-39 mm) from the radial styloid process and an average of 14.4 mm (range, 10-28 mm) from the DRUJ. Distal radial fractures overlapped an average of 11.8 mm from the radial styloid process and an average of 3.5 mm from the DRUJ. CONCLUSION: The pronator-sparing approach could be applied to a functionally reduced fracture because the non-overlapping area of the distal fracture fragment was > or =10 mm and it is possible to repair the anatomic plate without detaching the PQ muscle.