Ultrasonographic Assessment of the Pronator Quadratus Muscle after Surgical Treatment for Distal Radius Fractures

Dong Hyuk Choi; Hyun Kyun Chung; Ji Won Lee; Cheol Hwan Kim; Yong Soo Choi

doi:10.12671/jkfs.2017.30.2.69

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Choi, Chung, Lee, Kim, and Choi: Ultrasonographic Assessment of the Pronator Quadratus Muscle after Surgical Treatment for Distal Radius Fractures

Original Article

Journal of the Korean Fracture Society 2017; 30(2): 69-74.

Published online: 18 April 2017

DOI: https://doi.org/10.12671/jkfs.2017.30.2.69

Ultrasonographic Assessment of the Pronator Quadratus Muscle after Surgical Treatment for Distal Radius Fractures

Dong Hyuk Choi, M.D., Hyun Kyun Chung, M.D., Ji Won Lee, M.D., Cheol Hwan Kim, M.D., Yong Soo Choi, Ph.D.

Department of Orthopedic Surgery, Kwangju Christian Hospital, Gwangju, Korea.

Correspondence to: Yong Soo Choi, Ph.D. Department of Orthopedic Surgery, Kwangju Christian Hospital, 37 Yangrim-ro, Nam-gu, Gwangju 61661, Korea. Tel: +82-62-650-5064, Fax: +82-62-650-5066, stemcellchoi@naver.com

Received 28 March 2016 Revised 26 June 2016 Accepted 29 September 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to assess the morphological changes of the pronator quadratus (PQ) muscle using an ultrasonography in the volar locking plate fixation group and in the percutaneous K-wire fixation group for distal radius fracture, and to evaluate the impact on clinical outcomes.

Materials and Methods

Fifty-four patients who received surgical treatment for distal radius fracture were enrolled in this study. They were divided into two groups according to treatment modality: Group 1 included 34 patients who underwent internal fixation with volar locking plate and Group 2 included 20 patients with percutaneous K-wire fixation. Thickness of the PQ muscle was measured using an ultrasonography at the final follow-up. We evaluated the outcomes using the Mayo wrist score, wrist range of motion, and grip strength at the final follow-up.

Results

Compared with the uninjured side, thickness of the PQ muscle showed 31.9% of mean atrophy in Group 1 and 11.4% in Group 2. The atrophy of PQ muscle was severe in Group 1 (p=0.01). However, there was no significant difference in the mean Mayo wrist score between the two groups (83.1±10.9 in Group 1 and 80.2±8.9 in Group 2, p=0.28), except a mild limitation of pronation in Group 1.

Conclusion

The healed PQ muscle from fracture itself after distal radius fracture revealed a morphological atrophy. Moreover, the volar locking plate resulted in greater atrophy of the PQ muscle, but there was no specific impact on clinical outcomes.

Keywords: Distal radius fracture, Pronator quadratus, Ultrasonography

Figures and Tables

Fig. 1

Ultrasound examination in longitudinal view shows a significant decrease (40%) in the thickness of pronator quadratus muscle (arrows) at postoperative 21 months of volar locking plate.

Table 1

Demographic Characteristics

Variable	Group 1 (n=34)	Group 2 (n=20)	p-value
Mean age (yr)	59.9 (42–84)	57.1 (27–68)	0.10
Gender			0.90
Female	25 (73.5)	15 (75.0)
Male	9 (26.5)	5 (25.0)
Injured side			0.89
Dominant	21 (61.8)	13 (65.0)
Non-dominant	13 (38.2)	7 (35.0)
Mean follow-up (mo)	19.1 (12–33)	19.2 (12–36)	0.82
BMI	22.8±2.4	22.8±2.5	0.96
BMD (T-score)	−2.5±0.9	−2.3±0.6	0.42
AO fracture type			0.76
A	3 (8.8)	3 (15.0)
B	10 (29.4)	6 (30.0)
C	21 (61.8)	11 (55.0)

Values are presented as median (range), number (%), or mean±standard deviation. Group 1: patients of distal radius fractures treated with volar locking plate, Group 2: patients of distal radius fractures treated with percutaneous K-wire, BMI: body mass index, BMD: bone mineral density, AO: arbeitsgemeinschaft für osteosyntheses.

Table 2

Thickness of the Pronator Quadratus Muscle at the Final Follow-Up

Variable	Group 1	Group 2	p-value
Injured side (mm)	3.2±0.9 (68.1)	3.9±1.1 (88.6)	0.01
Uninjured side (mm)	4.7±0.9	4.4±0.9	0.27
p-value^*	<0.001	0.002

Values are presented as mean±standard deviation (percent of uninjured side). Group 1: patients of distal radius fractures treated with volar locking plate, Group 2: patients of distal radius fractures treated with percutaneous K-wire.

^*p-value: comparison with uninjured side in each group.

Table 3

Clinical Outcomes at the Final Follow-Up

Variable	Group 1	Group 2	p-value
Mayo wrist score	83.1±10.9	80.2±8.9	0.28
Range of motion (°)
Extension	63.1±9.7 (94.9)	61.9±7.4 (94.6)	0.86
Flexion	68.6±16.3 (93.4)	65.6±8.1 (92.4)	0.50
Supination	86.7±6.0 (98.5)	81.0±7.8 (97.5)	0.93
Pronation	67.3±9.0 (83.3)	79.7±9.2 (98.1)	0.02
Ulnar deviation	26.2±4.2 (93.2)	26.3±2.7 (92.4)	0.24
Radial deviation	18.5±2.0 (94.4)	17.4±2.7 (92.5)	0.61
Grip strength (kg)	21. 6±8.6 (91. 2)	22.1±7.4 (91.3)	0.84

Notes

^{Financial support} None.

^{Conflict of interests} None.

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