Double-blinded prospective cohort study (n=57, Level II) comparing clinical outcomes after volar locking plate fixation of distal radius fractures with versus without pronator quadratus repair. Primary outcome is DASH score at 1 year; secondary outcomes include wrist ROM, grip strength, and VAS pain.
When closing a volar plate case, you do not need to formally repair the PQ to achieve equivalent 1-year function — the key technical determinant of flexor tendon safety is plate position proximal to the watershed line, not soft tissue interposition.
Reserve the added complexity of PQ repair for cases where tissue quality allows an easy, tension-free closure, not as a routine step.
Double-blinded prospective cohort study (n=57, Level II) comparing clinical outcomes after volar locking plate fixation of distal radius fractures with versus without pronator quadratus repair. Primary outcome is DASH score at 1 year; secondary outcomes include wrist ROM, grip strength, and VAS pain.
When closing a volar plate case, you do not need to formally repair the PQ to achieve equivalent 1-year function — the key technical determinant of flexor tendon safety is plate position proximal to the watershed line, not soft tissue interposition.
Reserve the added complexity of PQ repair for cases where tissue quality allows an easy, tension-free closure, not as a routine step.