Role of the Pronator Quadratus in Distal Radius Fractures

Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Status: Completed

Conditions: Radius; Fracture, Lower or Distal End

Treatments: Procedure: Pronatus quadratus reparation

Study type: Interventional

Funder types: Other; NETWORK

Identifiers

NCT03371030

IIBSP-QUA-2017-36

Details and patient eligibility

About

The skin, the bones, and most muscles received branches from the source arteries of at least two angiosomes, thus revealing one of the important anastomotic pathways by which the circulation is reconstituted in those cases where a source artery is interrupted by disease or trauma.

There are numerous metaphyseal-epiphyseal branches arise within the pronator quadratus and the anterior interosseous artery and course towards the distal radius. These branches may be fundamental to the healing of the distal radius fractures and make nonunion a rare complication. The aim of this study is the evaluation of the role of the pronator quadratus muscle and its repair in volar approach in distal radius fractures treated with plate fixation.

Full description

Nonunion is an extremely rare complication in distal radius fractures and is most likely to occur in patients with conditions such as diabetes, peripheral vascular disease, or alcoholism. Diagnosis of nonunion is based on the absence of radiographic signs of union at 6 months. Treatment should be individualized but options are reconstructive procedures or wrist arthrodesis. In volar plating and often by the fracture injury itself, the complete pronator quadratus is stripped off the volar radius. Thus, the intraosseous collateral circulation must be sufficient for clinical healing. Any operative approach to the distal radius fracture should not compromise both volar radial and the dorsoulnar arteries.

While the branches to the pronator quadratus must be sacrificed in a palmar approach, the distal perforator can and should be spared. This is true even in the flexor carpi radialis extended approach. In distal radius fractures, when the normal outward flow of blood through the cortex is blocked, the periosteal arterioles have more ability than medullary arterioles to function and proliferate.

Enrollment: 100 patients

Sex: All

Ages: 18 to 90 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Distal radius fractures with intra-articular fragment, comminuted or displaced fracture
• Adults between 18- 90 years old

Exclusion criteria

• Children
• Non displaced distal radius fractures treated with immobilization.
• Adults older than 90 years old

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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100 participants in 2 patient groups

Pronator quadratus reparation

Experimental group

Description:

Surgical Intervention: Radius fracture teated with plate and pronator quadratus muscle repair.

Treatment:

Procedure: Pronatus quadratus reparation

No pronator quadratus reparation

Active Comparator group

Description:

Surgical Intervention: Radius fracture with plate without pronator quadratus muscle repair.

Treatment:

Procedure: Pronatus quadratus reparation