Pronator quadratus-sparing volar plating of distal radius fractures: A prospective study

Volar locked plates for the distal radius fractures (DRFs) are applied through the Henry approach, and its modification entails a routine step to disinsert the pronator quadratus from its radial and distal attachments. This muscle insertion is mostly fleshy with minimal tendinous tissue, and surgeons find it difficult to reattach at the end of the surgery, the hardware comes in direct contact with the flexor tendons.

The study was performed as a single-center prospective case series to investigate the possibility of preserving the pronator quadratus and, at the same time, achieving good reduction. Out of 73 patients enrolled in the study, the pronator quadratus was successfully spared in 60 patients. The quality of reduction and fixation in these patients was assessed functionally and radiologically.

Cases showed radiographic union commencing 3 months postoperatively. Twenty-nine cases had to wait for the 6th months follow up radiographs. No case had a nonunion of its fracture. The PQ sparing approach can be shifted to the FCR approach when needed. In our series, the pronator quadratus muscle was taken down in 4 patients, where a satisfactory reduction could not be achieved.

PQ sparing approach is readily adopted and can be used for the majority of DRFs, achieving a good functional and radiological outcome. Its use can enhance recovery and reduce hardware-related complications. Nonetheless, reduction should not be compromised, and the PQ sparing can be converted readily to the FCR approach.