Die topografische Beziehung des M. pronator quadratus zum Ansatz des M. brachioradialis – Implikationen für die Refixation nach palmarer Plattenosteosynthese distaler Radiusfrakturen

Zusammenfassung

Hintergrund: Der M. pronator quadratus (PQ) wird bei der palmaren Plattenosteosynthese einer distalen Radiusfraktur in der Regel an der radialen Radiuskante abgelöst. Eine Refixation des Muskels ist zur Erhaltung der normalen Pronationsfähigkeit des Unterarms und zur Bedeckung der Platte sinnvoll. Die Refixation des Muskels gelingt nicht immer befriedigend. In der vorliegenden Studie wird die topografische Beziehung des PQ zum Ansatz des M. brachioradialis (BR) im Hinblick auf eine Optimierung der Refixation des PQ bei der palmaren Plattenosteosynthese distaler Radiusfrakturen untersucht. Material und Methoden: Zwölf in Formalin fixierte Unterarmpaare wurden untersucht. Die muskulären Begrenzungen des PQ und der Ansatz des BR wurden präpariert, fotografiert und digital vermessen. Ergebnisse: Der PQ hat eine radiale Ansatzstrecke von durchschnittlich 4,75 cm. Distal besteht eine enge topografische Beziehung zwischen den Ansätzen des PQ und des BR. Eine fasziale Verbindung beider Muskeln konnte bei allen Präparaten nachgewiesen werden. Die gemeinsame Ansatzstrecke des PQ und des BR betrug 1,75 cm. Nach Entfernung der PQ-Faszie verblieben 0,85 cm. In 25 % bestand nach Entfernung der Faszie des PQ zudem eine muskuläre Verbindung zum BR. Schlussfolgerung: Es besteht eine bindegewebige, zum Teil muskuläre Verbindung zwischen dem distal-radialen PQ und BR-Ansatz. Bei der palmaren Plattenosteosynthese einer distalen Radiusfraktur kann der PQ unter Mitnahme eines Anteils des BR-Ansatzes vermutlich stabiler, im Gegensatz zu einer Naht innerhalb des Muskels, refixiert werden.

Abstract

Background: In open reduction and volar plate fixation of distal radius fractures, the pronator quadratus (PQ) muscle is usually detached at the radial edge of the distal radius. Repair of the muscle is reasonable for coverage of the plate and to maintain normal pronation of the forearm. However, repair of the muscle is not always satisfactory. In this study, the topographic relationship of both the PQ and the brachioradialis muscle (BR) insertions are investigated with regard to optimising the repair of the PQ in open reduction and volar plate fixation of distal radius fractures. Materials and Methods: Twelve forearm pairs fixed in formalin were examined. The muscular boundaries of the PQ and the insertion of the BR were dissected, photographs were taken and measured digitally. Results: The average distance of the PQ insertion was 4.75 cm. Distally, a close topographic relationship exists between the insertions of both the PQ and BR. A fascial connection of both muscles was detected in all specimens. The average distance of the common insertion was 1.75 cm. After removal of the PQ fascia, 0.85 cm of common insertion remained. In 25 % a muscular connection between both the PQ and BR was detected after removal of the PQ fascia. Conclusion: Both the PQ and BR have a common connective tissue and partially a common muscular insertion. Detaching the PQ insertion with a part of the BR insertion in open reduction and volar plate fixation of distal radius fractures can presumably lead to a more stable repair of the PQ in contrast to a repair within the muscle.

Schlüsselwörter

M.-pronator-quadratus-Refixation - distale Radiusfraktur - palmarer Zugang

Key words

M. pronator quadratus repair - distal radius fractures - volar plate fixation

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