The management of displaced diaphyseal forearm fractures in adults is predominately operative. Anatomical reduction is necessary to infer optimal motion and strength. The authors have observed an intraoperative technique where passive pronosupination is examined to assess quality of reduction as a surrogate marker for active movement.
We aimed to assess the value of this technique by intentionally malreducing a simulated diaphyseal fracture of a radius in a cadaveric model, and measuring the effect on pronosupination.
A single cadaveric arm was prepared and pronation supination was examined according to American Academy of Orthopaedic Surgeons guidance. A volar "Henry" approach was then performed and a transverse osteotomy achieved in the radial diaphysis. A locking plate was used to hold the radius in progressive amounts of translation and rotation, with changes in pronosupaintion measured with a goniometer.
The radius could be grossly malreduced with no effect on pronation and supination until the extremes of deformity. The forearm showed more tolerance with rotational malreduction than translation. Passive pronation was more sensitive for malreduction than supination.
The use of passive pronosupination to assess intraoperative quality of reduction is misleading and not advised.
Shields DW, Marsh MA, Aldridge SE and Williams JR