title: Dorsally displaced distal radius fractures treated by fixed-angle volar plating: Grip and pronosupination strength recovery. A prospective study.
abstract: BACKGROUND
  Malunion following open reduction and internal fixation of distal radius fracture threatens wrist function. Fixed-angle palmar plates provide rigid fixation that is stable over time; however, the pronator quadratus sectioning required by the anterior approach entails a risk of pronation strength loss and of distal radioulnar joint destabilization. The present study assessed recovery of grip, pronation and supination strength following such internal fixation.
  
  
  METHODS
  A prospective study included 26 distal radial fractures with dorsal displacement, osteosynthesized using a fixed-angle palmar plate, in 25 patients (mean age: 47.5 years; range: 17-72 years). Assessment concerned the classical parameters, plus grip and pronosupination strength recovery.
  
  
  RESULTS
  At a mean 14 months follow-up (range: 6-30 months), patients had recovered 91% grip strength, 88% pronation strength and 85% supination strength with respect to the healthy side. Complications comprised three cases of malunion, two of reflex sympathetic dystrophy syndrome, and four of post-traumatic carpal tunnel syndrome.
  
  
  CONCLUSIONS
  A study of the literature found 75-95% grip strength recovery following osteosynthesis using fixed-angle plates. Few studies, however, have focused on pronosupination strength, and none reported its evolution following osteosynthesis.
  
  
  CONCLUSIONS
  The present study found no drawbacks associated with a technique which usually involves sectioning the pronator quadratus. Except in case of malunion or joint stiffness, fixed-angle palmar plate osteosynthesis was followed by recovery of grip and pronosupination strength.
  
  
  METHODS
  Level IV: prospective non-randomized, non-comparative observational study.
authors.affiliation: Orthopedic Surgery Department, Annecy Regional Hospital, 1, avenue de l'Hôpital, 74374 Pringy, France. jmchirpazcerbat@ch-annecy.fr
authors.forename: J-M
authors.initials: JM
authors.lastname: Chirpaz-Cerbat
authors.forename: S
authors.initials: S
authors.lastname: Ruatti
authors.forename: C
authors.initials: C
authors.lastname: Houillon
authors.forename: S
authors.initials: S
authors.lastname: Ionescu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D053580:Muscle Strength; D053401:Palmar Plate / Q000601:surgery*; D011403:Pronation; D011446:Prospective Studies; D011885:Radius Fractures / Q000601:surgery*; D020127:Recovery of Function; D013484:Supination; D014955:Wrist Joint; D055815:Young Adult