Pronator quadratus preservation for distal radius fractures with locking palmar plate osteosynthesis. Surgical technique

Introduction. - A surgical technique is described to preserve the pronator quadratus muscle when fixing distal radius fractures with volar locking palmar plates. Technique. - Using a classic volar Henry approach to the wrist, the fibrous distal attachments of the pronator quadratus muscle are released. The locking palmar plate is passed under the pronator quadratus muscle and its correct placement is checked by fluoroscopy. Locking screws are inserted through mini-incisions in pronator quadratus. Discussion. - The pronator quadratus muscle plays an important role in wrist function, both in forearm pronation and as a stabilizer of the distal radioulnar joint. Mechanical impingement between the volar plate and the flexor tendons can cause adherences, ruptures and tenosynovitis. These should be reduced if pronator quadratus were intact. Conclusion. - Preservation of the pronator quadratus muscle is possible for the majority of the fractures of the distal radius treated with locking volar plate osteosynthesis. (C) 2009 Elsevier Masson SAS. All rights reserved.