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Diagnostic Value of Pronator Quadratus Muscle Thickness Measured by Ultrasonography in Predicting Occult Wrist Fractures

Year 2021, Volume: 4 Issue: 3, 90 - 95, 30.09.2021

Abstract

Aim: The aim of this study was to investigate the predictive power of pronator quadratus (PQ) muscle thickness, which is measured by focused ultrasonography, in patients applied to the emergency department (ED) with wrist trauma and without bone pathology detected in plain radiography.

Material and Methods: This prospective study was conducted in a tertiary ED. All patients’ measurements of the PQ muscle thickness in the longitudinal and transverse planes on both hand sides were performed by emergency medicine residents. For the diagnosis of an occult distal radius fracture and occult wrist injury, orthopedics and traumatology specialist's opinion, which was decided as a result of the outpatient follow-up and additional examinations was used as reference.

Results: No statistically significant difference was found between the PQ muscle thickness of 32 patients without occult wrist injury and 15 patients with occult injury and 6 patients with occult distal radius fracture. Also, no statistically significant difference was found between the PQ muscle thickness difference of the traumatic and non-traumatic sides.

Conclusions: Sonographic measurement of PQ muscle thickness may not an effective method to detect occult distal radius fracture and other occult wrist injuries.

References

  • Larsen CF, Mulder S, Johansen AM, et al. The epidemiology of hand injuries in The Netherlands and Denmark. European Journal of Epidemiology 2004;19(4):323–7. DOI: 10.1023/b:ejep.0000024662.32024.e3
  • Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. American Journal of Roentgenology 2008;190(1):10-6. DOI: 10.2214/AJR.07.2699
  • Gray H, Standring S, Ellis H, et al. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005.
  • MacEwan DW. Changes due to trauma in the fat plane overlying the pronator quadratus muscle: a radiologic sign. Radiology 1964;82(5):879-86. DOI: 10.1148/82.5.879
  • Curtis DJ, Downey Jr EF, Brower AC, et al. Importance of soft tissue evaluation in hand and wrist trauma: statistical evaluation. American Journal of Roentgenology 1984;142(4):781-8. DOİ: 10.2214/ajr.142.4.781
  • Sasaki Y, Sugioka Y. The pronator quadratus sign: its classification and diagnostic usefulness for injury and inflammation of the wrist. Journal of Hand Surgery Br 1989;14(1):80-3. DOİ: 10.1016/0266-7681(89)90021-1
  • Annamalai G, Raby N. Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures. Clinical Radiology 2003;58(10):798-800. DOI: 10.1016/S0009-9260(03)00230-7
  • Fallahi F, Jafari H, Jefferson G, et al. Explorative study of the sensitivity and specificity of the pronator quadratus fat pad sign as a predictor of subtle wrist fractures. Skeletal Radiology 2013;42(2):249-53. DOI: 10.1007/s00256-012-1451-0
  • Sun B, Zhang D, Gong W, et al. Diagnostic value of the radiographic muscle-to-bone thickness ratio between the pronator quadratus and the distal radius at the same level in undisplaced distal forearm fracture. European Journal Radiology 2016;85(2):452-8. DOI: 10.1016/j.ejrad.2015.12.002
  • Loesaus J, Wobbe I, Stahlberg E, et al. Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures. World Journal of Radiology 2017;9(9): 359-64. DOI: 10.4329/wjr.v9.i9.359
  • Sato J, Ishii Y, Noguchi H, et al. Sonographic swelling of pronator quadratus muscle in patients with occult bone injury. BMC Medical Imaging 2015;15:9. DOI: 10.1186/s12880-015-0051-6
  • Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2020/05/19.
  • Sato J, Ishii Y, Noguchi H, et al. Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers. Journal of Ultrasound Medicine 2014;33:111–7. DOI: 10.7863/ultra.33.1.111

Ultrasonografi ile Ölçülen Pronator Kuadratus Kası Kalınlığının Okült Bilek Kırıklarını Öngörmede Tanısal Değeri

Year 2021, Volume: 4 Issue: 3, 90 - 95, 30.09.2021

Abstract

Amaç: Bu çalışmanın amacı, acil servise el bileği travması ile başvuran ve direk grafide kemik patolojisi saptanmayan hastalarda odaklanmış ultrasonografi ile ölçülen pronator kuadratus (PQ) kas kalınlığının prediktif gücünün araştırılmasıdır.

Gereç ve Yöntemler: Bu prospektif çalışma üçüncü basamak bir acil serviste yürütülmüştür. Hastaların her iki taraftaki longitudinal ve transvers düzlemlerde tüm PQ kas kalınlığı ölçümleri acil tıp asistanları tarafından yapıldı. Gizli distal radius kırığı ve gizli el bileği yaralanmaları tanısı için ayaktan takip ve ek tetkikler sonucunda karar veren ortopedi ve travmatoloji uzman görüşü referans alındı.

Bulgular: Gizli bilek yaralanması olmayan 32 hasta ile gizli yaralanması olan 15 hastanın ve gizli distal radius kırığı olan 6 hastanın PQ kas kalınlıkları arasında istatistiksel olarak anlamlı bir fark bulunmadı. Ayrıca travmatik ve travmatik olmayan tarafların PQ kas kalınlık farkı arasında istatistiksel olarak anlamlı bir fark bulunmadı.

Sonuç: PQ kas kalınlığının sonografik ölçümü, gizli distal radius kırığını ve diğer gizli el bileği yaralanmalarını saptamak için etkili bir yöntem olmayabilir.

References

  • Larsen CF, Mulder S, Johansen AM, et al. The epidemiology of hand injuries in The Netherlands and Denmark. European Journal of Epidemiology 2004;19(4):323–7. DOI: 10.1023/b:ejep.0000024662.32024.e3
  • Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. American Journal of Roentgenology 2008;190(1):10-6. DOI: 10.2214/AJR.07.2699
  • Gray H, Standring S, Ellis H, et al. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh: Elsevier Churchill Livingstone; 2005.
  • MacEwan DW. Changes due to trauma in the fat plane overlying the pronator quadratus muscle: a radiologic sign. Radiology 1964;82(5):879-86. DOI: 10.1148/82.5.879
  • Curtis DJ, Downey Jr EF, Brower AC, et al. Importance of soft tissue evaluation in hand and wrist trauma: statistical evaluation. American Journal of Roentgenology 1984;142(4):781-8. DOİ: 10.2214/ajr.142.4.781
  • Sasaki Y, Sugioka Y. The pronator quadratus sign: its classification and diagnostic usefulness for injury and inflammation of the wrist. Journal of Hand Surgery Br 1989;14(1):80-3. DOİ: 10.1016/0266-7681(89)90021-1
  • Annamalai G, Raby N. Scaphoid and pronator fat stripes are unreliable soft tissue signs in the detection of radiographically occult fractures. Clinical Radiology 2003;58(10):798-800. DOI: 10.1016/S0009-9260(03)00230-7
  • Fallahi F, Jafari H, Jefferson G, et al. Explorative study of the sensitivity and specificity of the pronator quadratus fat pad sign as a predictor of subtle wrist fractures. Skeletal Radiology 2013;42(2):249-53. DOI: 10.1007/s00256-012-1451-0
  • Sun B, Zhang D, Gong W, et al. Diagnostic value of the radiographic muscle-to-bone thickness ratio between the pronator quadratus and the distal radius at the same level in undisplaced distal forearm fracture. European Journal Radiology 2016;85(2):452-8. DOI: 10.1016/j.ejrad.2015.12.002
  • Loesaus J, Wobbe I, Stahlberg E, et al. Reliability of the pronator quadratus fat pad sign to predict the severity of distal radius fractures. World Journal of Radiology 2017;9(9): 359-64. DOI: 10.4329/wjr.v9.i9.359
  • Sato J, Ishii Y, Noguchi H, et al. Sonographic swelling of pronator quadratus muscle in patients with occult bone injury. BMC Medical Imaging 2015;15:9. DOI: 10.1186/s12880-015-0051-6
  • Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com, updated 2013/04/06, accessed 2020/05/19.
  • Sato J, Ishii Y, Noguchi H, et al. Sonographic Appearance of the Pronator Quadratus Muscle in Healthy Volunteers. Journal of Ultrasound Medicine 2014;33:111–7. DOI: 10.7863/ultra.33.1.111
There are 13 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Gamze Çopuroğlu 0000-0002-0838-8746

Murat Yeşilaras 0000-0002-2357-1274

Yeşim Eyler 0000-0002-4024-7900

Ali Turgut 0000-0002-0429-2165

Turgay Yılmaz Kılıç 0000-0002-3494-5120

Publication Date September 30, 2021
Published in Issue Year 2021 Volume: 4 Issue: 3

Cite

AMA Çopuroğlu G, Yeşilaras M, Eyler Y, Turgut A, Kılıç TY. Diagnostic Value of Pronator Quadratus Muscle Thickness Measured by Ultrasonography in Predicting Occult Wrist Fractures. Anatolian J Emerg Med. September 2021;4(3):90-95.