The effect of splint use duration on pronator quadratus muscle repair in the fixation of distal radius fractures using volar plates

Distal radius fractures are among the most common orthopedic traumas. Stable fractures can be successfully treated with closed reduction and casting. Fragmented and unstable fractures result in serious complications if they are not properly treated, and a large majority of intra-articular fractures are treated surgically. We hypothesized that the use of long arm splint for 10 days is enough to reduce the tear of the repaired PQ muscle and positively affect the clinical results. After fracture fixation, the PQ muscle was repaired along the radial margin, and three radiopaque hemoclips were attached to the radial margin of the muscle. Patients were divided into groups with 10 days or 20 days of splint application. Follow-up X-ray evaluations were performed at 10 and 20 days, and at 1, 2, and 3 months postoperatively. Hemoclip displacement of ≥1 cm following surgical follow-up indicated repair failure. The mean time from injury to surgery was 11.2 h. A total of 30 patients, 19 (63%) men, and 11 (37%) women, with complete follow-up records, were evaluated and divided into two groups based on splint use duration. The maximum change in hemoclip location was 6 mm. Hemoclip displacement was not detected in any of the 30 patients. No statistically significant differences were found between the two groups. PQ muscle repairs are generally durable after fixation of distal radius fractures with anatomical volar plates. The splint use duration had no radiological or clinical effects on the PQ repair.

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1. Matullo KS, Dennison DG. Outcome following distally locked volar plating for distal radius fractures with metadiaphyseal involvement. Hand (NY). 2015;10:292-6.

2. Bartl C, Stengel D, Bruckner T, et al. The treatment of displaced intra-articular distal radius fractures in elderly patients. Dtsch Arztebl Int. 2014;111:779-87.

3. MacIntyre NJ, Dewan N. Epidemiology of distal radius fractures and factors predicting risk and prognosis. J Hand Ther. 2016;29:136-45.

4. Swigart CR, Badon MA, Bruegel VL, et al. Assessment of pronator quadratus repair integrity following volar plate fixation for distal radius fractures: a prospective clinical cohort study. J Hand Surg Am. 2012;37:1868-73.

5. Klug RA, Press CM, Gonzalez MH. Rupture of the flexor pollicis longus tendon after volar fixed-angle plating of a distal radius fracture: a case report. J Hand Surg Am. 2007;32:984-8.

6. Lee SK, Lee JW, Choy WS. Volar Stabilization of the Distal Radioulnar Joint for Chronic Instability Using the pronator quadratus. Ann Plast Surg. 2016;76:394-8.

7. Yoon A, Grewal R. Management of distal radius fractures from the North American perspective. Hand Clin. 2012;28:135-44.

8. McConkey MO, Schwab TD, Travlos A, et al. Quantification of pronator quadratus contribution to isometric pronation torque of the forearm. J Hand Surg Am. 2009;34:1612-7.

9. Gordon KD, Pardo RD, Johnson JA, et al. Electromyographic activity and strength during maximum isometric pronation and supination efforts in healthy adults. J Orthop Res. 2004;22:208-13.

10. Brown EN, Lifchez SD. Flexor pollicis longus tendon rupture after volar plating of a distal radius fracture: pronator quadratus plate coverage may not adequately protect tendons. Eplasty. 2011;11:e43.

11. Berglund LM, Messer TM. Complications of volar plate fixation for managing distal radius fractures. J Am Acad Orthop Surg. 2009;17:369-77.

12. Tanaka Y, Aoki M, Izumi T, et al. Effect of distal radius volar plate position on contact pressure between the flexor pollicis longus tendon and the distal plate edge. J Hand Surg Am. 2011;36:1790-7.

13. Aldemir C, Önder M, Doğan A, et al. Morphometric anatomic study and clinical significance of lunate fossa. Eklem Hastalik Cerrahisi. 2015;26:27-30.

14. Aldemir C, Duygun F. Is it possible to avoid intra-articular screw penetration with minimal use of fluoroscopy in the application of distal radius volar plate? Eklem Hastalik Cerrahisi. 2017;28:2-6.

15. Hershman SH, Immerman I, Bechtel C, et al. The effects of pronator quadratus repair on outcomes after volar plating of distal radius fractures. J Orthop Trauma. 2013;27:130-3.

16. Turhan S Sacral stress fracture in geriatrics: a case report. Turk J Geriatr 2017;20:70-2.