Eikrem Morten, Lian Tom, Madsen Jan Erik, Figved Wender
Orthopaedic Department, Aalesund Hospital, Moere and Romsdal Hospital Trust, Aalesund, NOR.
Institute of Clinical Medicine, University of Oslo, Oslo, NOR.
Cureus. 2024 Apr 19;16(4):e58576. doi: 10.7759/cureus.58576. eCollection 2024 Apr.
Background The advantage of pronator quadratus (PQ) repair following internal fixation via the volar approach in distal radius fracture (DRF) surgery remains unconfirmed in the literature. The aim of this study was to compare grip strength, patient-reported outcomes, and functional results between patients with an intact PQ and those with a ruptured PQ before undergoing surgery with a volar locking plate for dorsally displaced unstable extra-articular DRFs. Methods A total of 120 patients aged 55 years and older were included in a randomized controlled trial comparing a volar locking plate with a dorsal nail plate. Of the 60 patients randomized to the volar plate group, the integrity of the PQ muscle was recorded during surgery for 55 patients, who were included in this study. The outcomes measured were the Quick Disabilities of the Arm, Shoulder, and Hand Outcome Measure (QuickDASH) score, the Patient-Rated Wrist Evaluation (PRWE) score, the EQ-5D index, the visual analog scale (VAS) score, grip strength, and range of motion (ROM). Results The median age was 67 years (range 55 to 88), and the one-year follow-up rate was 98%. Patients with an identified intact PQ (28/55) before surgical release had better QuickDASH scores after one year (2.5 vs 8.0, mean difference 5.5, 95% CI: 1.3 to 9.8, p=0.028). Patients in the intact group also had better EQ-5D Index scores after one year (0.94 vs 0.85, mean difference 0.089, 95% CI: 0.004 to 0.174, p=0.031), and demonstrated better grip strength throughout the trial; after one year: 24 kg vs 20 kg (mean difference 3.9; 95% CI: 0.3 to 7.6, p=0.016). After one year, the intact group had regained 96% of their grip strength and the nonintact group had regained 93% of their grip strength compared to the uninjured side. The observed differences may be of questionable clinical importance, as they were lower than those of previously proposed minimal clinically important differences (MCIDs). Conclusions Patients with a DRF and a ruptured PQ prior to surgery exhibited higher QuickDASH scores and lower EQ-5D index scores after one year. The integrity of the PQ should be reported in future studies.
在桡骨远端骨折（DRF）手术中，经掌侧入路内固定后旋前方肌（PQ）修复的优势在文献中尚未得到证实。本研究的目的是比较在接受掌侧锁定钢板治疗背侧移位不稳定关节外DRF的患者中，术前PQ完整的患者与PQ断裂的患者之间的握力、患者报告的结局和功能结果。方法：总共120名55岁及以上的患者被纳入一项随机对照试验，比较掌侧锁定钢板和背侧髓内钉钢板。在随机分配到掌侧钢板组的60名患者中，55名患者在手术期间记录了PQ肌肉的完整性，并纳入本研究。测量的结局包括手臂、肩部和手部快速残疾评定量表（QuickDASH）评分、患者自评腕关节评估（PRWE）评分、EQ-5D指数、视觉模拟量表（VAS）评分、握力和活动范围（ROM）。结果：中位年龄为67岁（范围55至88岁），一年随访率为98%。术前确定PQ完整的患者（28/55）在一年后的QuickDASH评分更好（2.5对8.0，平均差异5.5，95%CI：1.3至9.8，p = 0.028）。完整组患者在一年后的EQ-5D指数评分也更好（0.94对0.85，平均差异0.089，95%CI：0.004至0.174，p = 0.031），并且在整个试验过程中握力表现更好；一年后：24千克对20千克（平均差异3.9；95%CI：0.3至7.6，p = 0.016）。一年后，与未受伤侧相比，完整组恢复了96%的握力，非完整组恢复了93%的握力。观察到的差异可能在临床重要性方面存疑，因为它们低于先前提出的最小临床重要差异（MCID）。结论：术前患有DRF且PQ断裂的患者在一年后表现出更高的QuickDASH评分和更低的EQ-5D指数评分。未来的研究应报告PQ的完整性。
