Minimally Invasive Pronator Quadratus Sparing Approach versus Extended Flexor Carpi Radialis Approach with Pronator Quadratus Repair for Volar Plating in Distal Radial Fractures

Abstract

Background Several volar plating techniques exist to treat distal radial fractures.

Question We investigated minimally invasive plate osteosynthesis (MIPO) with pronator quadratus (PQ) sparing versus conventional flexor carpi radialis approach for volar plating with PQ repair after distal radial fractures during the first postoperative year.

Patients and Methods Prospective data of two consecutive cohorts were compared: 62 patients in MIPO group with an average age of 61.2 years and 66 patients in PQ repair group with an average age of 61.4 years completed the entire follow-up period.

Results Range of motion was not significantly different, except flexion–extension that was significantly higher in the MIPO group. Quick Disabilities of the Arm, Shoulder and Hand was significantly lower in the MIPO group. Pain visual analogue scale was only significantly lower at 6 weeks. Grip strength measurements and patient satisfaction were not significantly different.

Conclusions MIPO volar plating with PQ sparing is a surgical technique that can be chosen according to surgeon's preference and expertise, resulting in a better flexion–extension mobility and function score according to our study.

Level of evidence This is a Level 3 study.

Keywords

minimally invasive - MIPO - distal radius - pronator quadratus - repair - sparing - volar plating

Note

The study was performed in Regional Hospital Tienen, Belgium.

Authors' Contributions

G.C.K. was the surgeon and lead investigator; N.D., resident and assistant investigator; K.VR, surgeon and assistant manuscript writer; S.P., researcher, statistics; J.F.G., surgeon and assistant manuscript writer.

Ethical Approval

Approval of the ethical board of our institution (ethical committee of Regional Hospital Tienen) was granted for this study.

Publikationsverlauf

Eingereicht: 15. Februar 2021

Angenommen: 21. April 2021

Artikel online veröffentlicht:
05. Juli 2021

• References

• 1 Ahsan ZS, Yao J. The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating. Hand (N Y) 2012; 7 (03) 276-280
• 2 Häberle S, Sandmann GH, Deiler S. et al. Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial. Eur J Med Res 2015; 20: 93
• 3 Hershman SH, Immerman I, Bechtel C, Lekic N, Paksima N, Egol KA. The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma 2013; 27 (03) 130-133
• 4 Mulders MAM, Walenkamp MMJ, Bos FJME, Schep NWL, Goslings JC. Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review. Strateg Trauma Limb Reconstr 2017; 12 (03) 181-188
• 5 Sonntag J, Woythal L, Rasmussen P. et al. No effect on functional outcome after repair of pronator quadratus in volar plating of distal radial fractures: a randomized clinical trial. Bone Joint J 2019; 101-B (12) 1498-1505
• 6 Liverneaux PA. The minimally invasive approach for distal radius fractures and malunions. J Hand Surg Eur Vol 2018; 43 (02) 121-130
• 7 Tang JB, Giddins G. Why and how to report surgeons' levels of expertise. J Hand Surg Eur Vol 2016; 41 (04) 365-366
• 8 Soong M, van Leerdam R, Guitton TG, Got C, Katarincic J, Ring D. Fracture of the distal radius: risk factors for complications after locked volar plate fixation. J Hand Surg Am 2011; 36 (01) 3-9
• 9 Soong M, Earp BE, Bishop G, Leung A, Blazar P. Volar locking plate implant prominence and flexor tendon rupture. J Bone Joint Surg Am 2011; 93 (04) 328-335
• 10 Kaiser P, Gruber H, Loth F, Schmidle G, Arora R, Gabl M. Positioning of a volar locking plate with a central flexor pollicis longus tendon notch in distal radius fractures. J Wrist Surg 2019; 8 (06) 482-488
• 11 Goorens CK, De Keyzer PB, Van Royen K, Provyn S, Goubau JF. Pronator quadratus repair after volar plate fixation in distal radial fractures: evaluation of the clinical and functional outcome and of the protective role on the flexor tendons-a randomized controlled study. Eur J Orthop Surg Traumatol 2021; 31 (03) 541-548
• 12 Hinds RM, Montero-Lopez N, Brock K. et al. Assessment of pronator quadratus repair integrity using dynamic ultrasonography following volar plate fixation for distal radius fractures. Hand (N Y) 2020; 15 (01) 111-115
• 13 Walch A, Erhard L, Vogels J, Pozzetto M, Gibert N, Locquet V. Ultrasound evaluation of the protector role of the pronator quadratus suture in volar plating. J Ultrasound Med 2019; 38 (10) 2785-2791
• 14 Swigart CR, Badon MA, Bruegel VL, Dodds SD. Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg Am 2012; 37 (09) 1868-1873
• 15 Zemirline A, Naito K, Lebailly F, Facca S, Liverneaux P. Distal radius fixation through a mini-invasive approach of 15 mm. Part 1: feasibility study. Eur J Orthop Surg Traumatol 2014; 24 (06) 1031-1037
• 16 Lee DY, Park YJ, Park JS. A meta-analysis of studies of volar locking plate fixation of distal radius fractures: conventional versus minimally invasive plate osteosynthesis. Clin Orthop Surg 2019; 11 (02) 208-219
• 17 Fan J, Zhang X, Ji JQ. et al. Fixation of distal radius fracture with volar locking palmar plates while preserving pronator quadratus through the minimally invasive approach. Technol Health Care 2021; 29 (01) 167-174