Role of the Pronator Quadratus in Distal Radius Fractures

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Role of the Pronator Quadratus in Vascularity and Stabilisation in Distal Radius Fractures After Osteosynthesis: Clinical and Anatomical Experimental Study

Conditions
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Radius; Fracture, Lower or Distal End

Intervention / Treatment
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* Procedure: Pronatus quadratus reparation


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pronator quadratus reparation<br>Surgical Intervention: Radius fracture teated with plate and pronator quadratus muscle repair. | Procedure: Pronatus quadratus reparation<br>* Displaced and intra-articular distal radius fractures treated with volar approach and plate fixation. Pronator Quadratus muscle repair.<br>|
| Active Comparator: No pronator quadratus reparation<br>Surgical Intervention: Radius fracture with plate without pronator quadratus muscle repair. | Procedure: Pronatus quadratus reparation<br>* Displaced and intra-articular distal radius fractures treated with volar approach and plate fixation. Pronator Quadratus muscle repair.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fracture consolidation | X-Ray radius union | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical stability | Clinical stability of the distal radioulnar joint | 3 months | 
| Radiological stability | Radiological stability of the distal radioulnar joint | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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distal radius fractures, pronator quadratus, osteosynthesis