Pronator quadratus repair after volar plating for distal radius fractures: A systematic review and meta-analysis of randomized controlled trials.

Objective: The purpose of the current study is to meta-analyze the randomized controlled trials in the literature comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures.

Methods: A search of the PUBMED/MEDLINE, EMBASE, and The Cochrane Library databases was performed. Any randomized con- trolled trials comparing pronator quadratus repair versus no repair alongside volar plating of distal radius fractures were included. The relevant information was collected by 2 blinded reviewers using a predetermined data sheet. Clinical outcomes were compared, with all statistical analyses performed using Review Manager Version 5.3.

Results: Five randomized controlled trials with 273 patients were included. There was no significant difference in the range of motion in flexion-extension, ulnar-radial deviation, or pronation-supination. There was a significant difference in favor of the no repair group for Disabilities of the Arm, Shoulder and Hand (DASH) Score (MD [Mean Difference]: 2.63, P < .0001) and pronation strength (MD: 13, P < .0001). Furthermore, there was no significant difference in the visual analog scale score. There were 3 complications relating to pronator quadratus repair, in which patients developed carpal tunnel syndrome requiring a release. There was no significant difference in the re-operation rate.

Conclusion: This study found that pronator quadratus repair when performing volar plating for distal radius fractures did not result in a significant improvement in functional outcome, range of motion, or strength.

Level of evidence: I, Systematic Review of Level 1 Studies, Level I, Therapeutic Study.