title: The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating.
abstract: BACKGROUND
  Open reduction internal fixation (ORIF) of distal radius fractures via a volar approach involves surgical release of the overlying pronator quadratus (PQ) muscle. Complete repair of the PQ, defined as full and stable replacement of the periphery of the PQ back to its original anatomic location, is not always possible upon conclusion of the operation. Postoperative consequences of incomplete PQ repair with regards to range of motion (ROM), grip strength, and complications are not well documented. It was hypothesized that the completeness of PQ repair would yield no significant difference in the postoperative ROM, grip strength, and incidence of complications.
  
  
  METHODS
  A retrospective review was performed of 110 repairs of distal radius fractures with ORIF via placement of a volar locking plate. The following clinical data were extracted: complete or incomplete PQ repair, patient age, gender, follow-up ROM/grip strength, and incidence of postoperative complications.
  
  
  CONCLUSIONS
  No significant difference in ROM, grip strength, and postoperative complications was detected between the complete and incomplete PQ repair groups. Complications consisted of two incidences of malunion requiring revision surgery and one occurrence of complex regional pain syndrome. There were no tendon ruptures. No statistical difference in ROM/grip strength or incidence of postoperative complications was detected between the complete and incomplete PQ repair groups. Regardless of the level of injury sustained by the PQ, surgeons should make an effort to cover the distal aspect of the volar plate during closure following distal radius fracture ORIF. Coverage of the distal aspect of the plate with the PQ (at a minimum) provides adequate results in ROM and grip strength, as well as protection against flexor tendon injury.
  
  
  METHODS
  Therapeutic Level III: Retrospective Comparative Study.
authors.affiliation: Indiana University School of Medicine, 635 Barnhill Drive, Indianapolis, IN 46202 USA.
authors.forename: Zahab S
authors.initials: ZS
authors.lastname: Ahsan
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Yao
keywords: Distal radius fracture; Open reduction internal fixation; Pronator quadratus; Volar locking plate