# Does Pronator Quadratus Repair Affect the Functional Outcome Following Volar Plate Fixation for Distal End Radius Fracture?

## TL;DR

This study found that repairing the pronator quadratus muscle during wrist surgery does not significantly improve long-term recovery outcomes.

## Contribution

The study provides evidence that pronator quadratus repair does not enhance functional outcomes in distal radius fracture surgery.

## Key findings

- No significant difference in six-month functional recovery between repair and non-repair groups.
- Initial improvements in pronation and wrist extension in the repair group did not translate to better grip strength or long-term outcomes.
- Multivariate analysis confirmed repair was not a significant predictor of functional outcomes.

## Abstract

Background and objective

Distal radius fractures represent the most common upper extremity injury requiring surgical intervention. Volar plate fixation necessitates division of the pronator quadratus muscle, yet the necessity of systematic muscle repair remains controversial. While some studies suggest enhanced functional outcomes with repair, others demonstrate equivalent recovery patterns regardless of muscle reconstruction. This study aimed to analyze functional outcomes following volar plate fixation for distal radius fractures, comparing patients with and without pronator quadratus repair.

Methodology

A retrospective cohort study was conducted involving sixty patients with displaced distal radius fractures treated with volar plate fixation between September 2023 and October 2024. Patients were stratified into pronator quadratus repair (n=31) and non-repair (n=29) groups. Functional assessment utilized the validated Patient-Rated Wrist Evaluation questionnaire at eight weeks, three months, and six months postoperatively. Additional measurements included range of motion parameters, grip strength assessment using standardized dynamometry, and isokinetic forearm rotation strength evaluation. Statistical analysis employed independent t-tests, chi-square tests, repeated measures analysis of variance, and multivariate linear regression modeling.

Results

No significant differences existed in baseline demographics between groups. Patient-Rated Wrist Evaluation scores demonstrated equivalent functional recovery at six months, with scores of 105.65 ± 13.15 versus 107.07 ± 12.43 (p=0.663). While initial advantages occurred in pronation strength 58.55 ± 4.12 degrees versus 55.17 ± 4.12 degrees (p=0.002) and wrist extension 65.97 ± 5.23 degrees versus 60.17 ± 1.63 degrees (p<0.001) in the repair group, grip strength showed no significant differences 6.16 ± 0.90 versus 6.07 ± 0.96 (p=0.695). Satisfactory isokinetic rotation strength was achieved in 71% versus 69% of patients, respectively (p=0.863). Multivariate regression confirmed that pronator quadratus repair was not a significant predictor of functional outcomes.

Conclusion

Pronator quadratus repair following volar plate fixation does not significantly improve long-term functional outcomes despite initial mild biomechanical advantages. These findings support surgical decision-making frameworks that prioritize operative efficiency without compromising patient care standards, while acknowledging potential protective benefits for soft tissue coverage.