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. 2023 Aug 30;11(8):e5227.
doi: 10.1097/GOX.0000000000005227. eCollection 2023 Aug.

Pronator Quadratus Muscle Flap for Prevention of Flexor Tendon Rupture after Distal Radius Volar Plating

Tarik M Husain  1 , Jacob I Jabbour  2 , Jack D Sudduth  3 , Anne-Sophie Lessard  4 , Carissa L Patete  5 , Zubin J Panthaki  4 , Gabe E Salloum  6
Affiliations

Pronator Quadratus Muscle Flap for Prevention of Flexor Tendon Rupture after Distal Radius Volar Plating

Tarik M Husain et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Flexor tendon rupture is a serious but rare complication that can occur after volar plating of distal radius fractures. This study aims to introduce a novel surgical technique that uses a pronator quadratus (PQ) muscle flap transposition to protect the flexor tendons from rupture or irritation and evaluate its outcomes.

Methods: A retrospective review was conducted on 204 patients with unstable distal radius fractures who underwent a standard volar flexor carpi radialis approach with extended release of the PQ muscle during exposure. A PQ muscle flap was harvested and transposed over the distal edge of the plate after open reduction and internal fixation of the distal radius. Postoperatively, patients were evaluated for flexor tendon irritation and rupture. Patients who had this injury before the use of the PQ flap were compared with the patients who received the PQ flap.

Results: Of the 204 patients, 119 received the PQ flap, and 85 did not. The mean follow-up time was 30.4 months. Among the patients who did not receive the PQ flap, five (5.9%) required plate removal or conservative treatment for tendon irritation or rupture. In contrast, only one patient (0.8%) who received the PQ flap required plate removal for flexor tendon irritation.

Conclusions: The PQ muscle flap is a quick and effective surgical technique that reduces the risk of flexor tendon rupture or irritation during distal radius fracture fixation. The PQ muscle flap acts as a buffer between the plate and tendon and is more effective than not transposing the muscle.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information.

Figures

Fig. 1.
Fig. 1.
Standard FCR approach with outline of the PQ muscle.
Fig. 2.
Fig. 2.
FCR approach with PQ muscle visualized.
Fig. 3.
Fig. 3.
Intraoperative view demonstrating anterior interosseous blood supply immediately proximal to forceps.
Fig. 4.
Fig. 4.
Clinical photograph of the PQ release.
Fig. 5.
Fig. 5.
Visualization of the plate over the radius and the PQ flap raised.
Fig. 6.
Fig. 6.
PQ muscle transposed, covering the plate completely.
Fig. 7.
Fig. 7.
Muscle flap inset.
Fig. 8.
Fig. 8.
Muscle perfusion before release.
Fig. 9.
Fig. 9.
Perfusion of muscle after it is released.
Fig. 10.
Fig. 10.
Perfusion of muscle after inset.
Fig. 11.
Fig. 11.
Perfusion of the muscle in color.
See this image and copyright information in PMC

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