The effect of brachioradialis tenotomy on wrist function and radiologic parameters in distal radius fractures

Although many fixation methods are used in distal radius fractures, the most preferred method is fixation with volar locking plates. In order for this determination to occur, it is possible with different urgical approaches. The standard Henry approach is the most preferred approach. In this approach, the tenotomy of the brachioradialis muscle is a matter of debate. Innervated by the radial nerve, this muscle supinates the forearm in flexion and pronation of the wrist. Our study was conducted as a prospective, single-center, randomized, controlled study. We included 49 patients who were admitted to the emergency department and outpatient clinic of Ankara University orthopedics and traumatology department due to distal radius fracture. We divided the patients into groups according to the Fernandez classification. The mean age was 49.8 years. We did not relax the brachioradialis muscle in 24 of 27 female and 22 male patients (Group 1). In 25 patients, we separated this muscle subperiosteally and fixed the brachioradialis tendon while covering the plate with pronator teres after fixation (Group 2). We used the same brand of plate and screw in all our patients. Preop, postoperative radial height, radial inclination, palmar tilt, ulnar variance were measured from the preoperative and postoperative posterior-anterior and lateral radiographs of the atients. In addition, preoperative and postoperative Arm, Shoulder and Hand Problems Questionnaire (DASH-T) scoring and visual analog scale (VAS) scoring were performed for functional evaluation. In order to evaluate the joint range of motion measurements, the elbow flexion angle in forearm neutral, elbow flexion angle in forearm supination, elbow flexion angle in forearm pronation, and forearm supination angle were operated by 2 different senior surgeons. Follow-up and evaluation of the patients were done by a single orthopedist. When the groups were compared within themselves, it was observed that the postoperative angles of the patients were closer to normal, their function scores were better, and their range of motion increased compared to the preoperative period. These differences were statistically significant (p<0.05). When the groups were compared with each other, radiological parameters, DASH-T score and range of motion of the groups were similar in the postoperative period. Only palmar tilt angle was statistically different between groups (p=0.03). However, this value was within normal limits in both groups. In addition, the VAS score was higher in patients who underwent relaxation, and this difference was statistically significant (p=0.02). Release of the brachioradialis tendon separates the distal fragment from the brachioradialis muscle and forearm fascia, which may facilitate reduction of the distal radial fragments during open reduction of a distal radius fracture. Therefore, there will be no significant loss of function in patients. However, it should not be forgotten that the pain will continue for a while in patients who are loosened. Key words: : distal radius fractures; fracture fixation; volar locking plates .