2023, Vol. 27 ›› Issue (31): 4959-4964

Preservation of pronator quadratus muscle combined with volar locking plate in the treatment of distal radial fractures

Huang Xiaoxia1, 2, 3, Jia Qiyu2, Erxat•Kerem4, Peng Cong2, Kong Weiqi2, Teng Yong3, Zhao Yan2   

Abstract: BACKGROUND: The most commonly used approach for distal radial fractures is the traditional Henry approach, but the pronator quadratus muscle needs to be cut off during operation. Failure to repair the pronator quadratus muscle will bring a series of complications.   
OBJECTIVE: To investigate the clinical effect of preserving pronator quadratus muscle and volar locking plate in the treatment of distal radial fractures.
METHODS: A retrospective case-control study was conducted to analyze the clinical data of 64 patients with distal radial fractures, including 32 patients in the modified group (preserving pronator quadratus muscle). According to AO classification, there were 8 cases of 23-B1 type, 7 cases of 23-B2 type, 7 cases of 23-B3 type, 6 cases of 23-C1 type, and 4 cases of 23-C2 type. In the traditional group (cutting the pronator quadratus muscle via traditional Henry approach), there were 32 cases. According to AO classification, there were 7 cases of 23-B1 type, 9 cases of 23-B2 type, 3 cases of 23-B3 type, 6 cases of 23-C1 type and 7 cases of 23-C2 type. The postoperative internal fixation, fracture healing, postoperative complications and other conditions of the two groups were observed, and the visual analog scale score of wrist pain was compared between the two groups. The wrist function of the patients was evaluated by Dienst joint score standard and the surgical effect was evaluated by imaging indicators.   
RESULTS AND CONCLUSION: (1) The average operation time and average intraoperative blood loss were significantly less in the modified group than those in the traditional group (Z=-6.77, P < 0.01; Z=-5.41, P < 0.01). (2) The average healing time in the modified group was shorter than that in the traditional group (Z=-2.08, P < 0.05). (3) At 12 months after operation, the excellent and good rates of the wrist function in the modified group and the traditional group were 94% (30/32) and 88% (28/32) respectively, with no significant difference (χ2= 0.767, P=0.682). (4) There was no significant difference in radial height, palmar inclination and ulnar deviation between the two groups shown by anteroposterior and lateral X-ray examination of wrist joint at 3 days, 1 and 3 months after operation (P > 0.05). (5) The visual analog scale score of the modified group was lower than that of the traditional group at 1 week, 1 and 3 months after operation (P < 0.05), but there was no significant difference in visual analog scale score between the two groups at 12 months after operation (P > 0.05). (6) There was no traumatic arthritis in both groups. In the traditional group, there were two cases of carpal tunnel syndrome (II stage removal of internal fixation device). (7) It is concluded that the modified Henry method with the preservation of pronator quadratus muscle has no significant advantages in the late pronation angle and pain. However, intraoperative surgery can shorten the operation time, reduce intraoperative bleeding, reduce early postoperative pain, and promote early activities.

Key words: distal radius, fracture, preservation, volar plate, pronator quadratus muscle, Henry approach