DOI: 10.25881/BPNMSC.2018.22.37.008

Authors

Maksimov B.I., Pandunc A.A., Vedernikov N.N.

Bauman City Clinical Hospital №29, Moscow.

Abstract

Over the last decades, we have observed a dramatic increase in the surgical management of distal radius fractures. Volar locking plating of distal radius fracture is a method of treatment which has become increasingly popular recently. In the standard volar approach to the distal radius, the release of m.pronator quadratus at its radial insertion may compromise this muscle’s function, blood supply to fracture fragments and, hence, affect recovery. The pronator-sparing technique spares division of the m.pronator quadratus at its radial border and utilizes subperiosteal dissection of this muscle. We report our technique for pronator-sparing surgical approach for the treatment of distal radius fractures using volar locking plates.

Keywords: osteosynthesis, distal radius, pronator-sparing surgical approach, m.pronator quadratus.

References

1. Ateschrang A, Stuby F, Werdin F, Schaller HE, Weise K, Albrecht D. Flexor tendon irritations after locked plate fixation of the distal radius with the 3.5 mm T-plate: identification of risk factors. Z Orthop Unfall. 2010;148:319-325.

2. Bell JS, Wollstein R, Citron ND. Rupture of flexor pollicis longus tendon: a complication of volar plating of the distal radius. J Bone Joint Surg Br. 1998;80(2):225–6.

3. Cannon TA, Carlston CV, Stevanovic MV, Ghiassi AD. Pronator-sparing technique for volar plating of distal radius fractures. J Hand Surg Am. 2014;39(12):2506-11.

4. Dos RC, Nebout J, Benlarbi H, Caremier E, Sam-Wing JF, Beya R. Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique. Chir Main. 2009;28:224-229.

5. Douthit JD. Volar plating of dorsally comminuted fractures of the distal radius: a 6-year study. Am J Orthop. 2005;34(3):140–7.

6. Fan J, Chen K, Zhu H, Jiang B, Yuan F, Zhu X, Mei J, Yu G. Effect of fixing distal radius fracture with volar locking palmar plates while preserving pronator quadratus. Chin Med J. 2014; 127: 2929-33.

7. Gordon KD, Dunning CE, Johnson JA, King GJ: Influence of the pronator quadratus and supinator muscle load on DRUJ stability. J Hand Surg Am. 2003;28:943-950.

8. Heidari N, Clement H, Kosuge D, Grechenig W, Tesch NP, Weinberg AM. Is sparing the pronator quadratus muscle possible in volar plating of the distal radius? J Hand Surg Eur Vol. 2012; 37: 402-6.

9. Heim U., Pfeiffer K. Internal fixation of small fractures, 3-rd ed., Berlin: Springer-Verlag; 1987.

10. Imatani J, Noda T, Morito Y, Sato T, Hashizume H, Inoue H. Minimally invasive plate osteosynthesis for comminuted fractures of the metaphysis of the radius. J Hand Surg Br. 2005;30:220-225.

11. Itoh S, Yumoto M, Kanai M, Yoshida W, Yoshioka T. Significance of a pronator-sparing approach for volar locking plate fixation of comminuted intra-articular fractures of the distal radius. Hand (NY). 2016;11(1):83-7.

12. Lo HY, Cheng HY. Clinical study of the pronator quadratus muscle: anatomical features and feasibility of pronator-sparing surgery. BMC Musculoskelet Disord. 2014; 15:136.

13. McConkey MO, Schwab TD, Travlos A, Oxland TR, Goetz T. Quantification of pronator quadratus contribution to isometric pronation torque of the forearm. J Hand Surg Am. 2009; 34: 1612-7.

14. Orbay JL. The treatment of unstable distal radius fractures with volar fixation. Hand Surg. 2000;5(2):103–12.

15. Orbay JL. Volar plate fixation of distal radius fractures. Hand Clin. 2005;21(3):347–54.

16. Orbay JL, Fernandez DL. Volar fixation for dorsally displaced fractures of the distal radius: a preliminary report. J Hand Surg [Am]. 2002;27(2):205–15.

17. Rey PB, Rochet S, Loisel F, Obert L. Technical note: How to spare the pronator quadratus during MIPO of distal radius fractures by using a mini-volar plate. Chir Main. 2014; 33: 95-9.

18. Sakamoto K, Nasu H, Nimura A, Hamada J, Akita K. An anatomic study of the structure and innervation of the pronator quadratus muscle. Anat Sci Int. 2014; Apr 12.

19. Sen MK, Strauss N, Harvey EJ: Minimally invasive plate osteosynthesis of distal radius fractures using a pronator sparing approach. Tech Hand Up Extrem Surg. 2008;12:2-6.

20. Smith DW, Henry MH. Volar fixed-angle plating of the distal radius. J Am Acad Orthop Surg. 2005;13(1):28–6.

21. Stuart PR: Pronator quadratus revisited. J Hand Surg Br.1996;21:714-722.

22. 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. 2012;37:1868–73.

For citation

Maksimov B.I., Pandunc A.A., Vedernikov N.N. Opportunities of preservation of the forearm pronator with the surgical treatment of fractures of the distal radius bone. Bulletin of Pirogov National Medical & Surgical Center. 2018;13(4):49-52. (In Russ.) https://doi.org/10.25881/BPNMSC.2018.22.37.008