The pronator quadratus is a flat square muscle at the distal forearm whose short tendinous fibres attach to the anterior radius. Its deep transverse fibres reinforce the DRUJ anterior capsule — making the pronator quadratus a secondary DRUJ stabiliser alongside the TFCC. In distal radius fracture ORIF via the Henry approach, the pronator quadratus is elevated as a flap and repaired after plate fixation to re-cover the hardware.
Forearm pronation (primary deep pronator); also contributes to DRUJ stability via its deep transverse fibres
Pronator quadratus repair after distal radius ORIF reduces hardware irritation and provides a soft tissue layer between the plate and the flexor tendons. The PQ flap repair uses 2-0 absorbable sutures to reattach the muscle belly over the plate. Inadequate PQ repair allows flexor pollicis longus tendon attrition rupture from contact with plate screws.
FPL abrasion on distal radius plate screws from inadequate pronator quadratus repair producing delayed tendon rupture managed with tendon repair and plate removal.
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