Abstract：Objective To investigate the effect of volar plate internal fixation with modified Henry approach with pronator quadratus preservation for distal radius fractures in elderly patients. Methods A retrospective case control analysis was performed on 78 elderly patients with distal radius fractures treated with volar plate internal fixation from February 2016 to December 2018 in Second Affiliated Hospital of Wenzhou Medical University and People`s Hospital of Qingtian. There were 36 males and 42 females, aged 60-79 years ［(66.5±5.6)years］. According to AO classification, there were 16 patients with type B1 fractures, 15 with type B2, 11 with type B3, 12 with type C1, 14 with type C2 and 10 with type C3. Of all, 40 patients were operated using modified Henry approach with pronator quadratus preservation (improvement group) and 38 using Henry approach with pronator quadratus cutting (traditional group). All patients were treated with volar plate internal fixation. The fracture healing, internal fixation and complications were observed. The wrist pain visual analogue score (VAS), forearm rotation range and grip strength were compared between the two groups at 1 week, 1 month, 3 months and 12 months postoperatively. The wrist joint function score of the two groups was compared by using the upper limb function assessment table (DASH) at 3 months and 12 months postoperatively. Results All patients were followed up for 12-24 months ［(15.2±6.3)months］. All fractures were healed after 3 months.The position of internal fixation was good, and there were no complications of infection, nonunion, plate loosening and tendon injury. During the follow-up period, 2 patients in traditional group had carpal tunnel syndrome, which was relieved after removal of internal fixation. The VAS in improvement group was lower than that in traditional group at 1 week, 1 month and 3 months postoperatively ［(6.17±0.40)points vs. (6.80±0.45)points, (5.54±0.40)points vs. (6.08±0.70)points, (3.18±0.30)points vs. (3.75±0.40)points, respectively］ (P<0.05). The forearm rotation range in improvement group was larger than that in traditional group at 1 week, 1 month and 3 months postoperatively ［(49.40±17.5)% vs. (40.3±13.2)%, (66.7±14.3)% vs. (54.2±18.7)%, (87.3±7.2)% vs. (80.7±8.1)%,respectively］（P＜0.05). There was no significant difference in VAS and forearm rotation range between the two groups at 12 months postoperatively (P>0.05). There was no significant difference in grip strength between the two groups at 1 week, 1 month, 3 months and 12 months postoperatively (P>0.05). There was no significant difference in DASH score between the two groups at 3 months and 12 months postoperatively (P>0.05). Conclusion For elderly patients with distal radius fracture, modified Henry approach with pronator quadratus preservation combined with volar plates is relatively better in alleviating postoperative pain, improving early rotation function and promoting early functional recovery.
