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pronator quadratus

Arnaud Walch, Lionel Erhard, Jerome Vogels, Marc Pozzetto, Nicolas Gibert, Vincent Locquet
The main complication of volar locking plates for distal radius fractures is flexor tendon rupture. The flexor pollicis longus (FPL) is the most commonly ruptured. Repair of the pronator quadratus (PQ) is one of the ways to prevent tendon rupture. The main purpose of this series was to evaluate the role of PQ repair after volar plating to prevent flexor tendon rupture using ultrasound (US). This work was a mono-operator prospective series of 20 consecutive patients with volar locking plates for distal radius fracture between September 2014 and May 2015...
February 18, 2019: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Damien Grinsell, Pradyumna Herle
BACKGROUND: Reconstruction of lip defects following neoplasia and trauma is a common procedure in plastic surgery. Reconstruction of large lip defects is a difficult undertaking and some degree of residual functional impairment and disability are likely to occur. Microsurgical reconstruction is the recommended technique for large lip defects; however, limitations exist regarding optimal aesthetic and functional outcomes with current free flap options. METHOD: We propose a new composite flap design based on the innervated pronator quadratus with the radial forearm free flap for a more dynamic reconstruction of total or near total lip defects...
February 1, 2019: ANZ Journal of Surgery
Fei Yu, You-Lai Yu, Su-Ping Niu, Pei-Xun Zhang, Xiao-Feng Yin, Na Han, Ya-Jun Zhang, Dian-Ying Zhang, Yu-Hui Kou, Bao-Guo Jiang
Multiple regeneration of axonal buds has been shown to exist during the repair of peripheral nerve injury, which confirms a certain repair potential of the injured peripheral nerve. Therefore, a systematic nerve transposition repair technique has been proposed to treat severe peripheral nerve injury. During nerve transposition repair, the regenerated nerve fibers of motor neurons in the anterior horn of the spinal cord can effectively grow into the repaired distal nerve and target muscle tissues, which is conducive to the recovery of motor function...
April 2019: Neural Regeneration Research
Jonathan E Miller, Aparajit Naram, BaiJing Qin, Douglas M Rothkopf
BACKGROUND: Distal radius fractures represent some of the most common injuries to the upper extremity, yet current evidence demonstrates great variability in the management of this injury. Elderly patients, in particular, stand to benefit from the early mobilization provided by operative fixation with a volar bearing plate. METHODS: We conducted a retrospective chart review on all patients 65 years or older who underwent unilateral open reduction internal fixation of distal radius fractures using a volar bearing plate at a single institution between January 2014 and January 2016...
October 15, 2018: Annals of Plastic Surgery
Christopher J Dy, David M Brogan, Berdale S Colorado
The branch of the anterior interosseous nerve to the pronator quadratus (PQ) is increasingly used as a donor nerve for end-to-end and reverse end-to-side nerve transfers. The anatomy of the PQ (and its nerve branch) is generally considered reliable in the absence of prior trauma. In this report, we describe a patient with an absent PQ despite intact clinical examination of other muscles supplied by the anterior interosseous nerve. The absence of the PQ precluded the use of its nerve as a donor nerve for transfer...
October 1, 2018: Journal of Hand Surgery
Lauren Elisabeth Wessel, Danielle Christine Marshall, Jeffrey Gei-Hun Stepan, Hayley Anne Sacks, Ogonna Kenechi Nwawka, Theodore T Miller, Duretti Teferi Fufa
PURPOSE: The purpose of this study was to identify associations between the clinical manifestations of carpal tunnel syndrome (CTS) and the sonographic measurements of the median nerve in the carpal tunnel. We hypothesized that sonographic changes in the median nerve from proximal to distal along the carpal tunnel would be associated with symptom severity scores. METHODS: We report on 38 patients with clinical signs and symptoms of CTS in a prospective investigation...
September 18, 2018: Journal of Hand Surgery
Aurélie Sarcher, Sylvain Brochard, François Hug, Guy Letellier, Maxime Raison, Brigitte Perrouin-Verbe, Morgan Sangeux, Raphaël Gross
BACKGROUND: The aim of this study was two-fold: (1) to quantify the variability of upper limb electromyographic patterns during elbow movements in typically developing children and children with unilateral spastic cerebral palsy, and to compare different amplitude normalization methods; (2) to develop a method using this variability to detect (a) deviations in the patterns of a child with unilateral spastic cerebral palsy from the average patterns of typically developing children, and (b) changes after treatment to reduce muscle activation...
September 5, 2018: Clinical Biomechanics
Bernd Hohendorff, C Knappwerth, J Franke, L P Müller, C Ries
INTRODUCTION: Stable pronator quadratus repair following volar plate fixation of distal radius fractures with complete plate coverage is difficult. MATERIALS AND METHODS: This study compares a modified pronator quadratus repair technique involving the brachioradialis muscle insertion (test group) with a conventional radial incision through the muscle without pronator quadratus repair (standard group). This prospective randomised study included 16 patients in the test group and 12 in the standard group; all were available for clinical, radiographic and ultrasound examination at a mean follow-up of 15 months...
October 2018: Archives of Orthopaedic and Trauma Surgery
Richard M Hinds, Nicole Montero-Lopez, Kenneth Brock, Ronald Adler, Anthony Sapienza, John T Capo, Nader Paksima
BACKGROUND: Previous work evaluating the pronator quadratus (PQ) muscle following volar plate fixation (VPF) of distal radius fractures (DRF) suggests that PQ repair often fails in the postoperative period. The purpose of this investigation was to assess PQ repair integrity following VPF of DRF using dynamic musculoskeletal ultrasonography. METHODS: Twenty adult patients who underwent VPF of DRF with repair of the PQ with a minimum follow-up of 3 months underwent bilateral dynamic wrist ultrasonography...
July 1, 2018: Hand: Official Journal of the American Association for Hand Surgery
Francois Loisel, Hugo Kielwasser, Grégoire Faivre, Thomas Rondot, Séverin Rochet, Antoine Adam, Pauline Sergent, Grégoire Leclerc, Laurent Obert, Daniel Lepage
Internal fixation with volar locking plates has revolutionized the treatment of distal radius fractures. Manufacturers have introduced plate designs that closely follow the anatomy of the distal radius. However, use of volar plates has also led to the emergence of new types of complications. While the use of monoaxial or polyaxial locking screws and of minimally invasive techniques (arthroscopy, preservation of pronator quadratus) increases the cost of the surgical procedure, it results in a tangible benefit for patients, allowing them to move their wrist almost immediately after surgery and to quickly regain their autonomy...
July 12, 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
C K Spies, M Langer, L P Müller, J Oppermann, S Löw, F Unglaub
BACKGROUND: The functionality of the upper extremity is decisively based on rotation of the forearm. The rotation depends on the extent of motion of the distal radioulnar joint. Rotation enables complete and focused usability of the hand in order to cope with daily activities. The configuration of the distal radioulnar joint has developed over millions of years of evolution. ANATOMIC CONDITIONS: The triangular fibrocartilage complex is the crucial stabiliser of the latter joint since osseous structures are limited...
August 2018: Der Orthopäde
Jae-Man Kwak, Gu-Hee Jung
BACKGROUND: Volar locking plating through the flexor carpi radialis is a well-established technique for treating unstable distal radial fractures, with few reported complications. In certain circumstances, including metaphyseal comminuted fractures, bridge plating through a pronator quadratus (PQ)-sparing approach may be required to preserve the soft tissue envelope. This study describes our prospective experience with bridge plating through indirect reduction. METHODS: Thirty-three wrists (four 23A2, six 23A3, 15 23C1, and eight 23C2) underwent bridge plating through a PQ-sparing approach with indirect reduction from June 2006 to December 2010...
April 14, 2018: BMC Musculoskeletal Disorders
Ezequiel Ernesto Zaidenberg, Ezequiel Martinez, Carlos Rodolfo Zaidenberg
Various methods have been reported to treat forearm nonunions with good results. However, in the presence of infection, inadequate vascularity of surrounding tissues, or failed prior grafts, vascularized bone grafts are a valid alternative. We describe the surgical technique to obtain distal radius vascularized bone graft pedicled on the radial artery (RA) and its clinical application in 1 case of an ulnar nonunion. We studied the surgical technique in 12 freshly injected cadavers. In the distal forearm, the RA provides several periosteal branches to supply the distal radius metaphysis...
July 2018: Journal of Hand Surgery
C K Goorens, K Van Royen, S Grijseels, S Provyn, J De Mey, T Scheerlinck, J F Goubau
Flexor tendon injury after volar plating of distal radius fractures is due to friction against the plate. To assess this risk, the distance between the flexor pollicis longus (FPL) and the volar prominence of the plate was measured with ultrasonography under various conditions: a standard plate fixed proximal or distal to the watershed line and a low-profile volar rim plate, with and without transection of the pronator quadratus (PQ). Distance from the FPL to the volar prominence of the plate decreased significantly when the PQ was cut and when a standard plate was placed distal to the watershed line, with the tendon often bulging over the plate...
June 2018: Hand Surgery and Rehabilitation
Mitsuhiko Nanno, Norie Kodera, Yuji Tomori, Shinro Takai
INTRODUCTION: The purpose of this study was to compare the movement of the flexor pollicis longus (FPL) tendon on the distal radius during wrist and finger motions before and after removal of a volar plate in patients with distal radius fractures using transverse ultrasound and to evaluate the kinematic effects on the FPL by the removal. METHODS: Twenty-five patients with distal radius fracture were evaluated quantitatively by transverse ultrasound using coordinates for the movement of the FPL on the distal radius during wrist and finger motions before and after the plate removal...
January 2018: Journal of Orthopaedic Surgery
Yuka Igeta, Paul Vernet, Sybille Facca, Ismaël Naroura, Juan José Hidalgo Diaz, Philippe A Liverneaux
The minimally invasive flexor carpi radialis approach can be used for volar locking plate fixation of distal radius fractures. After 15-mm incision on the lateral aspect of the FCR tendon and all structures but the radial artery are reclined ulnarly, a plate is inserted under the pronator quadratus just proximal to the "watershed line." The distal epiphyseal screws are put in place, and the proximal part of the plate is exposed by flexion of the wrist to put in place the proximal screws. No drainage or postoperative immobilization is used...
December 2018: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Joseph Bader, Michael R Boland, Desney Greybe, Arthur Nitz, Timothy Uhl, David Pienkowski
This study aimed to provide quantitative activation data for muscles of the forearm during pronation and supination while using a power grip. Electromyographic data was collected from 15 forearm muscles in 11 subjects while they performed maximal isometric pronating and supinating efforts in nine positions of forearm rotation. Biceps brachii was the only muscle with substantial activation in only one effort direction. It was significantly more active when supinating (µ = 52.1%, SD = 17.5%) than pronating (µ = 5...
February 8, 2018: Journal of Biomechanics
Philippe A Liverneaux
This article reviews the author's currently used minimal invasive approach for volar plating of distal radius fractures. A single longitudinal incision of 1.5 cm is drawn on the lateral aspect of the flexor carpi radialis tendon in order to insert a plate under the pronator quadratus. With the wrist flexed, the plate is applied on the anterior cortex of the radius to reduce the fracture. This approach offers the advantage of preserving ligamentotaxis, which facilitates the reduction, and the small scar improves the cosmetics...
February 2018: Journal of Hand Surgery, European Volume
Christopher J Burke, James S Babb, Ronald S Adler
The aim of this study was to assess changes in shear wave velocity within the pronator quadratus muscle in patients following volar plate fixation for distal radial fractures compared to the contralateral nonoperated side. Shear wave velocity values were obtained in the short and long axis of the pronator quadratus muscle, which were analyzed separately. Patients were also stratified by age below or above 66 years. Statistical analysis was performed using paired sample Wilcoxon signed rank and t tests. Pearson and Spearman rank correlations were also used...
November 2017: Ultrasound: Journal of the British Medical Ultrasound Society
Hui-Kuang Huang, Jung-Pan Wang, Ming-Chau Chang
Flexor tendon injury is a rare, but serious, complication after volar plate fixation for distal radius fractures. The plate position and prominence at the watershed line are contributing factors that cause flexor tendon injury. With the standard volar approach, the pronator quadratus (PQ) is typically elevated off the radial attachment. The distal part of the plate is often visible after repair of the PQ. We describe a "PQ-splitting" technique for covering the distal edge of the plate if primary PQ repair cannot completely cover the distal part of the plate...
November 2017: Journal of Hand Surgery
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