Repair or Not Repair Pronator Quadratus in the Volar Plating of Distal Radial Fracture-Are Functional Outcomes Differ ?

In the operation of distal radial fractures, the volar plating techniques become popular. During the surgical approach, the pronator quadratus (PQ) muscle needs split or full-thickness strip to exposure the fracture site and facilitate the instrumentation of the plate. Generally, the PQ would be repaired. Sometimes, the PQ is damaged by the fracture fragment so severely that it is difficult to repair the PQ. However, there is few reviews paper to discuss the consequence of the unrepaired or repaired PQ and the AAOS guideline1 of the treatment of distal radial fracture in 2009 did not even list the management of the PQ. The function of the PQ includes pronation and stability of the distal radial-ulnar joint (DRUJ). According to the study, the elimination of PQ function will cause a significant decrease in pronation torque, which is supposed to affect the function of the wrist in the daily life. The theoretical benefits of the repair of the pronator quadratus include flexor tendon protection3,4, remain of the normal pronation-supination range of motion (ROM) and strength, and keeping the stable DRUJ.