Clinical Utility of the Pronator Quadratus Sign: A Systematic Review and Meta-Analysis

Area of Science:

• Radiology
• Orthopedics
• Diagnostic Imaging

Background:

• The pronator quadratus fat pad (PQFP) sign is an indirect radiographic marker for distal radius and wrist fractures.
• Its diagnostic reliability has been inconsistently reported, necessitating a comprehensive evaluation.

Purpose of the Study:

• To systematically review and meta-analyze the diagnostic accuracy and prognostic value of the PQFP sign in identifying wrist and distal radius fractures.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched major electronic databases up to September 2025 for relevant studies.
• Included studies on plain radiographs or ultrasound, with advanced imaging or clinical follow-up as reference standards.

Main Results:

• Pooled analysis of six datasets showed moderate diagnostic performance (sensitivity 0.65, specificity 0.85) with significant heterogeneity.
• Five studies indicated a positive PQFP sign increased fracture risk by 2.44-fold (RR=2.44).
• Sensitivity analysis excluding ultrasound data confirmed a significant increase in fracture likelihood.

Conclusions:

• The PQFP sign demonstrates moderate specificity but variable sensitivity for distal radius fractures.
• A positive PQFP sign significantly elevates the probability of an underlying fracture, suggesting further imaging.
• Due to heterogeneity and modest sensitivity, the PQFP sign should not be the sole basis for excluding fractures.