Isokinetic evaluation of pronation after volar plating of a distal radius fracture

Does the pronator-sparing approach improve functional outcome, compared to a standard volar approach, in volar plating of distal radius fractures? A prospective, randomized controlled trial

BACKGROUND

This study aimed to compare functional outcomes of a volar plate osteosynthesis for distal radius fractures (DRF) performed with either a standard volar approach (SVA), which required detachment of the pronator quadratus muscle, or a pronator-sparing approach (PqSA).

MATERIALS AND METHODS

This prospective randomized controlled study included 106 patients scheduled for volar plate osteosyntheses. Patients were allocated to either the SVA group (n = 53) or the PqSA group (n = 53). Patients were blinded to treatment until completion of the study. The primary outcome measure was the Patient-Rated Wrist Evaluation (PRWE). Secondary outcome parameters were the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Modified Mayo Wrist Score (MMWS). Follow-up examinations were performed at 8 weeks and 3, 6, and 12 months postoperatively.

RESULTS

Overall, 91 patients were included in the final analysis: 48 in the SVA group and 43 in the PqSA group. The two cohorts were not significantly different in demographic characteristics, including age, sex, injuries on the dominant side, type of injury, and fracture classification. We found significant differences between groups at 6 months in the mean PRWE (SVA: 12.3 ± 10.4, PqSA: 18.9 ± 14.11 points) and in the mean DASH score (SVA: 12.3 ± 11.9, PqSA: 19.3 ± 16.7 points), which favoured the SVA. We found no significant differences between groups in the MMWS or in the PRWE and DASH scores at any other time points.

CONCLUSIONS

This randomized comparative clinical trial failed to demonstrate that a volar plate osteosynthesis performed with a PqSA could improve the outcome, compared to the SVA, in patients with DRF.

LEVEL OF EVIDENCE

II Trial registration Comparison of Two Volar Plating Systems for Distal Radius Fractures, ClinicalTrials.gov (NCT03474445), registered 22 March 2018, retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03474445?cond=radius&cntry=AT&draw=2&rank=1.

Does access through the pronator quadratus influence pronation strength in palmar plate fixation of distal radius fractures in elderly patients?

INTRODUCTION

Palmar plate fixation of the distal radius fracture involves dissecting the pronator quadratus (PQ). This is regardless of whether the approach is radial or ulnar to the flexor carpi radialis (FCR) tendon. It is not yet clear whether and to what extent this dissection leads to a functional loss of pronation or pronation strength. The aim of this study was to investigate the functional recovery of pronation and pronation strength after dissection of the PQ without suturing.

MATERIALS AND METHODS

From October 2010 to November 2011, patients aged over 65 with fracture were prospectively enrolled in this study. Fracture stabilisation was performed via the FCR approach without suturing the PQ. Follow-up examinations took place 8 weeks and 12 months postoperatively, and pronation and supination strength were analysed by means of an especially developed measuring device.

RESULTS

212 patients were initially screened and 107 were enrolled. The range of motion compared to the healthy opposite side was Ext/Flex 75/66% 8 weeks postoperatively. Pronation was 97% with a pronation strength of 59%. After 1 year, the scores improved to Ext/Flex 83/80%. Pronation recovered to 99% and pronation strength to 78%.

CONCLUSION

The present study can show a recovery of pronation as well as pronation strength in a large patient population. At the same time, the pronation strength is still significantly lower 1 year after the operation than on the opposing healthy side. As the pronation strength recovers as the grip strength and is at all times on a par with the supination strength, we believe that we can continue to refrain from re-fixating the pronator quadratus.

IS VOLAR PLATING IN DISTAL RADIUS FRACTURES SAFE REGARDING PRONATOR QUADRATUS?

ABSTRACT Objective: This study aimed to investigate whether isokinetic strength decrease significantly after using volar plating for distal radius fractures and evaluate the pronator quadratus muscle regarding atrophy. Methods: This study took place between 2011 and 2015 and included 18 distal radius fracture patients (group 1) who were treated via volar plating at least one year prior and 14 healthy controls (group 2). All participants were tested isokinetically. Grip strength, radiological evaluation, wrist range of motion, disabilities of the arm, shoulder, and hand and visual analog scale scores were assessed for clinical and functional outcomes. Ultrasonography evaluated the pronator quadratus muscle thicknesses. Results: The peak supination torque (PT) and supination work per repetition (WPT) strength values significantly decreased (p:0.039, p:0.025, respectively). Although we determined an 11% pronation PT deficit and a 19% pronation WPT deficit, neither were significant. In group 1, the pronator quadratus muscle thickness decreased 5.9% ± 13.3 in the radial area and 9.7% ± 10.5 in the interosseous area according with ultrasonography; these results were not statistically significant compared to group 2. All clinical and functional outcomes were not statistically significant between the groups. Conclusion: The use of volar plating after distal radius fractures is a safe method regarding isokinetic strength and pronator quadratus muscle atrophy. Level of evidence III; Retrospective case-control study .

Should We Repair the Pronator Quadratus in a Distal Radius Fracture with an Ulnar Styloid Base Fracture? A Biomechanical Study

Background  Merits of repairing the pronator quadratus (PQ) to restore distal radioulnar joint (DRUJ) stability after a volar approach remain controversial. Distal radius fractures are often associated with ulnar styloid fractures (USF). When involving the fovea, this USF can lead to a DRUJ instability. The PQ repair may be key in reducing this DRUJ instability. Methods  This study aims to assess the biomechanical role of PQ repair in a cadaveric model of USF. In 17 forearm specimens, a USF including the fovea was executed. Positional changes of the DRUJ in forearm rotation and dorso-palmar (DP) translation were measured with variable loads (0, 2.5, and 5N) applied to the PQ origin. Results  Forearm rotation and DP-translation decreased significantly with PQ loading of 5N, changing on average by 5 degrees and 0.6 mm, respectively. Conclusion  We found a significant decrease in forearm rotation and DP-translation comparing a fully loaded PQ to an unloaded PQ in our cadaveric model.

Volar plating: functional recovery of the pronator quadratus

Purpose

The pronator quadratus (PQ) is reflected in the surgical approach to the distal radius. This study explores the functional strength of PQ, 12 months after volar plating without repair of PQ.

Methods

A total of 135 patients were identified from our prospectively collected database. All volunteers had grip strength and pronation power tested in the treated and contralateral forearms at 45, 90 and 135 degrees of elbow flexion using a custom-built torque measuring device and hydraulic hand dynamometer to evaluate forearm pronation.

Results

Twenty-seven participants were included in the study. No significant difference was identified in mean peak pronation torque between the volar plated and non-treated forearms. Pronation strength was identified as being independent of angle of elbow flexion. Grip strength was correlated with forearm pronation showing no significant difference between groups.

Conclusions

Our results suggest adequate long-term (15–32 months) functional recovery of the pronator quadratus after volar plating.

Level of Evidence

III.

A Comparison of Pronator Quadratus Preservation and Dissection Approaches for Volar Plating of Comminuted Intra-articular Distal Radius Fracture

PURPOSE

Although the pronator quadratus (PQ) preservation approach for volar plating of distal radius fracture has been commonly used recently, its superiority to the conventional PQ dissection approach, especially for comminuted intra-articular distal radius fractures, has not been well established. The purpose of this study was to assess the efficacy of PQ preservation for comminuted intra-articular fractures and to evaluate the healed PQ during hardware removal surgery.

MATERIALS AND METHODS

From January 2014 to March 2019, 86 patients who underwent both volar plating for AO Foundation/Orthopedic Trauma Association classification type C2 or C3 distal radius fractures and subsequent hardware removal were assessed in this study. Radiographic measurements, clinical outcomes at each follow-up, and the integrity of healed PQ during hardware removal were compared between the PQ dissection (group D) and PQ preservation (group P) groups.

RESULTS

Complete union with acceptable reduction on radiographic measurements was achieved in both groups. Group P showed a statistically significant earlier recovery of clinical outcomes at 2 weeks and 1 month postoperatively and improved anatomical restoration of PQ muscle covering the plate, which was identified during hardware removal surgery. Flexor tendon rupture was identified in 2 patients (5%) and tenosynovitis in 6 patients (14%) in group D; no patient had flexor tendon rupture (0%), and 2 patients (5%) had tenosynovitis in group P.

CONCLUSIONS

Pronator quadratus preservation approach for volar plating is easily applicable and useful even for comminuted intra-articular distal radius fractures and is helpful for earlier restoration of wrist function and in preventing flexor tendon problems in the latter postoperative period.

Do we really need to repair the pronator quadratus after distal radius plating?

PURPOSE

Fractures of distal radius are one of the common orthopaedic injuries. Placing the plate on volar surface requires release of underlying pronator quadratus (PQ) muscle. No consensus is present in the literature about the repair or not of the PQ. The purpose of this study was to evaluate the influence of PQ repair on functional outcome and complications.

METHODS

Retrospectively 83 patients of distal radius fractures managed with volar plating between 2014 and 2016 were evaluated. Demographic data, operative notes and physical therapy records were retrieved. Patients were divided into group A where PQ repair was done and group B where no repair was done. Functional data such as range of motion (ROM), grip strength, visual analogue scale (VAS) score and disabilities of arm, shoulder and hand (DASH) score at 4 weeks, 3 months, 6 months and finial follow-up were retrieved.

RESULTS

Totally 63 patients (n = 29 in group A and n = 34 in group B) with the mean age of 51.64 years were examined. Patients were followed up for a mean of 35.2 months (range 27.2-47.1 months) in group A and 38.6 months (range 28.6-51.0 months) in group B. Though functional outcome of the affected limb was not significantly different between two groups after 3 months, PQ repair did affect the recovery at an early stage. Repair group had significantly better ROM (p = 0.0383) and VAS score at 4 weeks (p = 0.017) while grip strength (p = 0.014) was significantly better at 3 months.

CONCLUSIONS

Repair of PQ may provide pain relief and increased ROM in early postoperative period and hence every attempt should be made to achieve the repair.

A Novel Technique to Assess Distal Radioulnar Joint Stability Using Increasing Torque

Background  Previous studies on computed tomography (CT) in patients with a suspected triangular fibrocartilage complex (TFCC) injury have not been successful in assessing distal radioulnar joint (DRUJ) laxity. The aim of this study was to develop a novel servomotor-driven device for the assessment of DRUJ by applying increasing torque to the DRUJ in pronation and supination. Methods  A custom-built device was designed to function during four-dimensional (4D) CT of the wrist. A torque meter, positioned between the incoming hand holder, and a direct current (DC) servomotor were used for angular positioning and for applying rotational force to the patient's arm. A total of 110 healthy participants were recruited to gather reference values for the range of motion (ROM), maximum torque in neutral and supinated/pronated position, and the ability to withstand an increasing, device-generated torque in these positions. The device was also used during 4D DRUJ CT in five patients with suspected TFCC injuries. Results  A gender- and age-relevant reference chart for ROM and torque was created. Men showed a tendency (ns) toward having a larger ROM and increasing strength with increasing age, whereas women showed the opposite. Also, the dominant hand showed a tendency toward having a larger ROM and being stronger than the nondominant hand (ns). A smaller cohort of patients ( n  = 5) with suspected TFCC injuries showed a significantly decreased ability to withstand increasing torque in both supination (2.1 ± 0.3 vs. 3.1 ± 0.2 s; p  < 0.005) and pronation (2.3 ± 0.5 vs. 3.1 ± 0.4 s; p  < 0.0005) and also showed a clear laxity on real-time 4D CT image sequences. Decreased strength at all positions was also found (average 74% decrease compared to noninjured side). Conclusion  Reference values for torque strength and ability to withstand increasing torque can be used clinically in the assessment of patients with symptoms that could represent ligamentous injuries to the TFCC. The ability to use the device during CT enables radiographic evaluation of instability during increasing torque. Level of Evidence This is a Level II study.

Longitudinal recovery following distal radial fractures managed with volar plate fixation

AIMS

To synthesise the literature and perform a meta-analysis detailing the longitudinal recovery in the first two years following a distal radius fracture (DRF) managed with volar plate fixation.

MATERIALS AND METHODS

Three databases were searched to identify relevant articles. Following eligibility screening and quality assessment, data were extracted and outcomes were assimilated at the post-operative time points of interest. A state-of-the-art longitudinal mixed-effects meta-analysis model was employed to analyse the data.

RESULTS

The search identified 5698 articles, of which 46 study reports met the selection criteria. High levels of disability and impairment were reported in the immediate post-operative period with subsequently a rapid initial improvement followed by more gradual improvement for up to one year. The results highlight that the period associated with the greatest physical recovery is in the first three months and suggest that the endpoint of treatment outcomes is best measured at one year post-surgery.

CONCLUSION

Clinically meaningful improvements in outcomes can be expected for 12 months, after which progress plateaus and reaches normal values. This paper adopted a novel approach to meta-analyses in that the research question was of a longitudinal nature, which required a unique method of statistical analysis. Cite this article: Bone Joint J 2017;99-B:1665-76.

Repair of the pronator quadratus after volar plate fixation in distal radius fractures: a systematic review

To position the volar plate on the distal radius fracture site, the pronator quadratus muscle needs to be detached from its distal and radial side and lifted for optimal exposure to the fracture site. Although the conventional approach involves repair of the pronator quadratus, controversy surrounds the merits of this repair. The purpose of this study was to compare the functional outcomes of patients with distal radius fractures treated with pronator quadratus repair after volar plate fixation versus no pronator quadratus repair. A systematic search was conducted in Medline, EMBASE and the Cochrane Central Register of Controlled Trials, on 23 July 2015. All studies comparing pronator quadratus repair with no pronator quadratus repair in adult patients undergoing volar plate fixation for distal radius fractures were included. The primary outcome was the Disability of the Arm, Shoulder and Hand (DASH) score at 12 months. Secondary outcomes included range of motion, grip strength, post-operative pain and complications. A total of 169 patients were included, of which 95 underwent pronator quadratus repair, while 74 patients underwent no pronator quadratus repair. At 12 months follow-up no statistically significant differences in DASH-scores and range of motion were observed between pronator quadratus repair and no repair. Moreover, post-operative pain and complication rates were similar between both groups. At 12 months of follow-up, we do not see any advantages of pronator quadratus repair after volar plate fixation in the distal radius. However, a definitive conclusion cannot be drawn from this systematic review due to a lack of available evidence.

A comparison of minimally invasive approach vs conventional approach for volar plating of distal radial fractures

Background

The aim of this study was to introduce and to evaluate the functional results of volar plating of distal radial fractures through a longitudinal minimally invasive approach.

Methods

From January 2010 to January 2013, 157 patients with distal radial fractures were randomly allocated to group A (n = 83; 49 men, 34 women; mean age: 42 (18–67)) and B (n = 74; 46 men, 28 women; mean age: 41 (22–65)), including type A2, A3, B3, C1, and C2 fractures, based on AO Foundation and Orthopaedic Trauma Association Classification. Patients in group A were treated through a 1.5- to 2-cm longitudinal incision, and patients in group B were treated through the conventional flexor carpi radialis approach. All fractures were treated with a locking volar plate. The functional results were compared with range of motion, grip and pronation strengths for each fracture type.

Results

After a follow-up of 2 years, similar measurements were noted on range of motion and grip strength in both groups. Regarding pronation strength, group A was superior to group B (p < 0.05).

Conclusions

Minimally invasive volar plating of distal radial fractures is a safe and reliable technique, resulting in better pronation function and appearance.

Level of Evidence

Level I, Therapeutic study

[Descriptive, radiographic, topographic and functional anatomy applied to distal radius fractures]

Extensive anatomical knowledge is needed in order to correctly treat distal radius fractures: normal and pathological osteology of the distal radius, distal radio-ulnar joint and radiocarpal joint-both on the descriptive and functional level-the neurovascular and muscular environments of the distal radius-which are essential to the surgical approaches-and the angles that need to be restored during the reduction. All of these concepts are broached in this article.

Sonographic Quantification of Pronator Quadratus Activity During Gripping Effort

OBJECTIVES

The aim of this study was to obtain quantitative data related to the activity of each head of the pronator quadratus based on dynamic sonographic parameters during gripping effort and to assess their relationships with grip and pronation strengths.

METHODS

The forearms of 33 healthy volunteers were evaluated at 5 positions of axial rotation (full supination, 45° supination, neutral, 45° pronation, and full pronation). Echogenic intensity ratios and muscle thicknesses of each head of the pronator quadratus were measured from transverse cross-sectional sonograms obtained during maximal grip and release. Grip strengths and maximal isokinetic pronation torques at 90°/s and 360°/s were evaluated as strength parameters and correlated with sonographic measures.

RESULTS

Echogenic intensity ratios of both heads significantly decreased during power grip (P ≤ .002). Changes in echogenic intensity ratios of the superficial head were greater when the forearm was pronated compared to supination (P < .001), whereas changes in echogenic intensity ratios of the deep head were constant at all forearm positions. Muscle thicknesses of the superficial head maximally increased at the neutral position during power grip (P < .001), whereas muscle thicknesses of the deep head did not change. There were significant negative correlations between grip strength and echogenic intensity ratios of both heads at all respective forearm positions (P ≤ .048). Pronation torque was significantly correlated with echogenic intensity ratios of the superficial head at all forearm positions and the deep head at 45° and full pronation positions (P ≤ .034).

CONCLUSIONS

The data revealed that the superficial head of the pronator quadratus more actively contracts when the forearm is in pronation, whereas the deep head constantly contracts at all positions. This study suggests that both heads of the pronator quadratus also play a role in grip strength, but the superficial head contributes more to pronation strength.

Pronator quadratus repair after volar plating of distal radius fractures or not? Results of a prospective randomized trial

BACKGROUND

The purpose of the present study was to investigate the influence of the pronator quadratus (PQ) muscle repair following volar plate fixation of distal radius fractures with special regards to the forearm pronation strength. During the early recovery period of 3 months, an improvement of pronation strength and functional scorings was hypothesized for the PQ repair when compared to no repair.

METHODS

The inclusion criteria were (1) men or women between 18 and 80 years, (2) isolated, closed fractures of the distal radius, (3) A2 to B2 types of fracture according to the AO fracture classification system, (4) primary volar locking plate osteosynthesis. Patients were randomized to group A = PQ repair and group B = no repair. Follow-up examinations after 6 and 12 weeks included bilateral isometric pronation strength measurement, range of motion, the QuickDASH and the Mayo-Wrist-Score, and a visual analog scale (VAS).

RESULTS

60 patients (n = 31 in group A and n = 29 in group B) with an average age of 54 years (range 22-77 years) returned for both follow-up visits. The pronation strength measurements showed no significant differences between groups (PQ repair vs. no repair) neither at 6 weeks nor at 12 weeks. Additionally, no statistical significant differences were noted for ROM, QuickDASH-Score or Mayo-Wrist-Score. The VAS scoring revealed a significant decreased pain level after PQ repair at 6 weeks postoperatively (p = 0.017).

CONCLUSION

An improved pronation strength after PQ repair in the early rehabilitation period could not be confirmed. However, the PQ repair might reduce pain in the early postoperative period.

TRIAL REGISTRATION NUMBER

NCT02595229 (ClinicalTrials.gov, registered 02 November 2015).

Supination and Pronation Strength Deficits Persist at 2-4 Years after Treatment of Distal Radius Fractures

Forearm rotation is a key function in the upper extremity. Following distal radius fracture, residual disability may occur in tasks requiring forearm rotation. The objectives of this study are to define pronation and supination strength profiles tested through the range of forearm rotation in normal individuals, and to evaluate the rotational strength profiles and rotational strength deficits across the testing range in a cohort of patients treated for distal radius fracture associated with an ulnar styloid base fracture. In a normative cohort of 29 subjects the supination strength profile showed an increasing linear relationship from supination to pronation. Twelve subjects were evaluated 2-4 years after anatomical open reduction and volar plate fixation of a distal radius fracture. The injured wrist was consistently weaker (corrected for hand dominance) in both supination and pronation strength in all testing positions, with the greatest loss in 60 degrees supination. Mean supination strength loss across all testing positions was significantly correlated with worse PRWE scores, highlighting the importance of supination in wrist function.

Examination of the pronator quadratus muscle during hardware removal procedures after volar plating for distal radius fractures

BACKGROUND

It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes.

METHODS

We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length.

RESULTS

The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores.

CONCLUSIONS

This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

Forearm post-traumatic deformities: classification and treatment

INTRODUCTION

There is no classification for acquired forearm deformities. A clinical-radiographic study was conducted to classify these deformities and evaluate the results.

MATERIALS AND METHODS

Thirteen patients with forearm deformities following traumas or their treatment were included (11 men and two women, from 2000 to 2010). Mean age was 31 years (range 10-75 years). Initial treatment was conservative in five patients and surgical in eight patients. One segment was affected in seven patients (the radius in four patients, the ulna in three), and both segments were affected in six patients. Location assessment: 2 projections X-rays, including wrist and elbow. Deformity location: proximal, diaphisary, distal, defined with the abbreviation, in distal sense, R1, R2, R3 for the radius, and U1, U2, U3 for the ulna. Primary and secondary deformities were distinguished: secondary deformities occurred later in a different location than the primary one. Six patients were treated with plate and screws. An external fixator was used in six patients. One patient was treated with bone resection. Iliac crest bone graft was used in 10 patients, and vascularised fibula graft in one patient.

RESULTS

The primary deformity affecting the radial diaphysis (R2) determined a secondary deformity in four patients: in the distal ulna (U3) with ulnocarpal dislocation in three patients and in the distal radius (R3) in one patient. Results of osteosynthesis treatment were excellent in one patient, satisfactory in four and unsatisfactory in one. External fixation was excellent in one patient and satisfactory in five. Bone resection was satisfactory in one patient.

DISCUSSION

Surgical treatments with osteosynthesis are the major cause of acquired forearm deformities in adults. Location and aetiology of the deformities are essential for the surgical indication and the result. It is important to restore the length of the deformed segment, realigning the anatomical axis. X-rays enable clinicians to distinguish between primary and secondary forearm deformities.

CONCLUSION

Characteristics and locations of post-traumatic deformities were identified. The major location is diaphisary and distal, the elbow is rarely affected. The functional consequence is a limitation in the range of motion of the hand. The best results are achieved with short-term treatment.

[Is there any correlation between the strength of pronation and supination of the dominant hand and that of the non-dominant one in right-handed healthy adults: preliminary results]

We searched the existence of a link between the strength of pronation and supination of the dominant forearm and those of the non-dominant one. Ninety-seven volunteers were tested in pronation and supination with an analog dynamometer. Gender, age, dominance, height and weight were recorded. The measurement position was: 90° of elbow flexion, 0° of shoulder abduction, wrist slightly extended and neutral pronation-supination. We took four measurements per patient: strength in pronation and supination, in both the dominant and non-dominant sides. Fifteen subjects were evaluated twice. The left-handed (4) were removed from the statistical analysis. There were 38 men (37 years, 18-66) and 55 women (45 years, 21-71). Torques were higher (P<0.05) in men than in women, higher in supination than in pronation and in the dominant side compared to the non-dominant one (average ratio "non-dominant/dominant": 0.85; σ=0.16). There was a strong correlation between non-dominant hand strength and dominant hand strength (Pearson>0.6). Relating to the 15 subjects evaluated twice, the value of the forces varied during the day, but the ratio "non-dominant/dominant" was constant. The left-handed people were excluded, their values may be different from those of right-handers, as has been shown for grip strength. There was a strength variation during the day, but the ratio "non-dominant/dominant" was constant, making it more relevant intra-individual comparison (non-dominant side versus dominant side) rather inter-individual (based on charts of gender, age, weight and height). In the right-handed, the ratio "strength non-dominant side/dominant" is constant, defining easily in consultation the expected value of recovery of an injured forearm.

The effect of a Galeazzi fracture on the strength of pronation and supination two years after surgical treatment

The aim of this study was to determine the effect of a Galeazzi fracture on the strength of pronation and supination at a mean of two years after surgical treatment. The strength of pronation and supination was measured in varying rotational positions of the forearm of ten male patients (mean age 38.9 years (21 to 64)) who had undergone plate fixation for a Galeazzi fracture. The stability of the distal radioulnar joint was assessed, and a clinical assessment using the quick-Disabilities of the Arm Shoulder and Hand (quickDASH) questionnaire and patient-related wrist examination (PRWE) scores was undertaken. In addition, the strength of pronation and supination was measured in a male control group of 42 healthy volunteers (mean age 21.8 years (18 to 37)).

The mean absolute loss of strength of supination in the injured compared with the non-injured arm throughout all ranges of forearm rotation was 16.1 kg (sem 5.3), corresponding to a relative loss of 12.5% (95% confidence interval (CI) 3.6 to 21.4). For the strength of pronation, the mean loss was 19.1 kg (sem 4.5), corresponding to a relative loss of 27.2% (95% CI 14.2 to 40.1). Loss of strength of supination following a Galeazzi fracture correlated with poor quickDASH (p = 0.03) and PRWE scores (p < 0.01).

Loss of strength of pronation (27.2%), and of supination (12.5%) in particular, after a Galeazzi fracture is associated with worse clinical scores, highlighting the importance of supination of the forearm in function of the upper limb.

Cite this article: Bone Joint J 2013;95-B:1508–13.

Prospective evaluation of pronator quadratus repair following volar plate fixation of distal radius fractures

PURPOSE

To evaluate the efficacy of pronator quadratus (PQ) repair after volar plating of distal radius fractures.

METHODS

All consecutive distal radius fractures treated operatively with a volar plate during a 1-year period were assigned to receive a repair of the PQ versus no repair. Surgical exposure, reduction, and postoperative rehabilitation were equivalent in both groups. Clinical outcomes with a minimum follow-up of 12 months were assessed via range of motion; grip strength; Disabilities of the Arm, Shoulder, and Hand (DASH) scores; and visual analog scale (VAS) scores.

RESULTS

A total of 60 consecutive distal radius fractures were treated operatively with a locking volar plate. Full follow-up data were available for 33 patients in the PQ repair group and 24 patients in the control group. At 12 months, the mean DASH score was 8 for the repair group and 5 for the control group. Range of motion at the wrist, grip strength, and VAS scores were also not significantly different between groups. In addition, we found no significant differences in any of the parameters at the 2-, 6-, or 12-week intervals, although we observed greater grip strength and wrist flexion in the repair group at 6 weeks. Reoperation was required for 4 patients in the repair group and 1 in the control group.

CONCLUSIONS

Pronator quadratus repair after volar plating of a distal radius fractures did not significantly improve postoperative range of motion, grip strength, or DASH and VAS scores at 1 year. The rates of reoperation between groups were not significantly different.