Background: Flexor tenosynovitis and tendon rupture are rare, yet serious complications after treatment of a fractured distal radius with a volar plate. The highest incidents of rupture are associated with the plate on or distal to the watershed line of the radius. While studies have shown that reattachment of the pronator quadratus (PQ) following plating does not lead to improved measures in grip strength or range of motion, it may reduce the incidence of these complications. Reattachment of the PQ after a standard approach does not often capture the distal edge of the plate. We report results of a new rotational muscle flap technique for improved coverage. Methods: The PQ of 13 cadaver forearms were exposed. The muscle was then raised and a volar distal radius plate was applied to the forearm. The PQ was repositioned over the plate and photographed to document its initial plate coverage area. Varying amounts of rotational back cutting were utilized to reposition the PQ. The amount of plate coverage was then analyzed. Results: Varying amounts of back cutting of the PQ increased the coverage of the distal radius plate, from a 54% increase from a 25% cut up to an 82% increase from a 75% cut. However, rotation of the muscle flap from larger back cuts will increase distal coverage at the expense of proximal coverage. Conclusions: Repair of the PQ to cover the volar plate after distal radius open reduction internal fixation is often di¯cult. When utilizing a PQ back-cut technique, surgeons can achieve improved coverage of distal radius plates by the PQ flap.

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