44. QUANTIFICATION OF PRONATOR QUADRATUS CONTRIBUTION TO ISOMETRIC PRONATION TORQUE OF THE FOREARM

Abstract

Purpose: Open reduction internal fixation with a volar plate is a popular surgical option for distal radius fractures. The pronator quadratus (PQ) must be stripped from the distal radius in this procedure. PQ is an important pronator of the forearm and stabilizer of the distal radioulnar joint. The purpose of this study was to investigate pronation torque in healthy volunteers before and after temporary paralysis of the PQ with lidocaine under EMG guidance.

Method: A custom-made apparatus was built to allow isometric testing of pronation torque at 5 positions of rotation: 90° of supination, 45° of supination, neutral, 45° of pronation and 80° of pronation. It was validated using a test-retest design with 10 subjects. For the study, 17 (9 male, 8 female) right hand dominant volunteers were recruited. They were tested at all 5 positions in random order and then had their PQs paralyzed with lidocaine. Repeat testing was performed in the same random order 30 minutes after injection. Three subjects underwent unblinded testing with saline injected instead of lidocaine.

Results: After paralysis of PQ with lidocaine, pronation torque decreased by 23.2% (p=0.0010) at 90° of supination, 16.7% (p=0.0001) at 45° of supination, 22.9% (p=0.0002) in the neutral position, 20.4% (p=0.0066) at 45° of pronation and 22.2% (p=0.0754) at 80° of pronation. All were statistically significant except 80° of pronation. Peak torque values before and after injection were highest in the supinated positions (8.2 Nm at 45° supination) and decreased gradually as the subjects were in more pronated positions (1.8 Nm at 80° pronation). The test-retest trial demonstrated no evidence of fatigue with repeated testing. The subjects who underwent injection of saline demonstrated no evidence of pronation torque loss secondary to pain or a pressure effect of the injectate.

Conclusion: This study demonstrated a significant decrease in pronation torque with controlled elimination of PQ function. Open reduction internal fixation of distal radius fractures damages the PQ. This may result in a pronation torque deficit. Functional significance of this loss should be shown. Pronation torque measurement may add to postoperative outcome analysis of surgical procedures about the wrist.