Repair of Pronator Quadratus With Partial Muscle Split and Distal Transfer for Volar Plating of Distal Radius Fractures

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. We also report the outcome of our series. This method can potentially prevent direct gliding of flexor tendons on the distal part of the plate and prevent flexor tendon attrition on the plate prominence.