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Biomechanical Comparison of Pronator Quadratus Repair Techniques in the Modified Henry Approach for Distal Radius Fracture

Background: Open reduction and volar plate fixation of distal radius fracture frequently involve detaching the pronator quadratus muscle. Repair maybe difficult due to friable muscle fascia or bulky plate. This study evaluates the strength of 3 repair techniques. Methods and Results: Repair with separate Simple Sutures, Continuous Suture, or Suture Anchors was tested on 3 groups of 6 cadaver forearms. A distraction load was applied to all repairs on a traction simulator until there was a failure of either the suture, the muscle or the anchor. Simple Suture group could resist 20.7 N, the Continuous Suture group 33.3 N, and the Suture Anchors group 42.5 N. The load to displacement were, respectively, 20.0, 25.9, and 34.6 N. The mode of failure was noted. Conclusions: This cadaveric study shows that if deemed necessary for soft tissue coverage or for biological aid in fracture healing, suture anchor is the strongest repair choice for pronator quadratus. This conclusion must be weighed against the fact that no in vivo tensile strength value sustained by the pronator quadratus is known in the literature and that simple suture could be sufficient to hold the repaired muscle while the wrist is immobilized postoperatively.