Clinical applications of internal fixation via the volar approach with pronator quadratus preservation for distal radius fractures

Background/aim: The purpose of this study is to investigate the success rate of volar plate treatment of distal radius fractures with preservation of the pronator anterior muscle; the incidence of complications, such as infection, vascular nerve injury, and tendon injury; fracture healing rate; and changes in muscle anatomy. Materials and methods: The Henry approach was adopted to treat distal radius fractures with pronator quadratus (PQ) preservation on a trial basis. Between June 2015 and January 2017, 46 cases of distal radius fractures were considered according to the Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification. The PQ was preserved, the distal margin was exposed, and a fracture reset was completed by pulling the muscles toward the near side. The K-wires were temporarily fixed, and the plate was placed by a plate channel. The mean operation duration was 52 min and the average blood loss was approximately 30 mL. There were no implant failures, adhesions requiring tenolysis, and tendon rupture. No patient developed carpal tunnel syndrome. All fractures healed without infection, radial artery injury, nerve damage, tendon rupture, and nonunion. A guider was applied to implant a screw under the muscle. Results: In total, 46 patients with PQ preservation between ages 29 to 52 were performed distal radius fracture surgery. AO classification revealed that there were four cases of type A, seven cases of type B3, 10 cases of type C1, 13 cases of type C2, and 12 cases of type C3. For most fractures, such as Types A, B3, C1, C2, and C3, the fracture sites were located around the muscle distal margin. Thus, slight pulling of the muscles to the near side can reveal the fracture, and surgery with PQ preservation can be implemented. The postoperative muscle structures found during hardware removal procedures were similar to the muscle structures before the first operation. The radiographic outcome of fracture fixation was satisfactory. Conclusion: Surgery with PQ preservation is suitable for most distal radius fractures other than Types B1 and B2. For a small part of fractures involving the shaft of the radius, the PQ needed to be partially cut off to complete the operation. The postoperative muscle structures were close to normal.