This study aimed to comparatively observe the effects of the volar plate for preserving the pronator quadratus (PQ) during distal radius fracture treatment. The patients were divided into the PQ preservation group (preservation group) and the PQ suture group (suture group), and the drainage amount and PQ function recovery time were recorded after internal fixation. Some of the patients underwent computed tomography scanning to measure wrist muscle thickness, and we exposed and measured the PQ width and thickness intraoperatively and performed a pathological examination. Anatomical differences in the PQ were noted between the two groups. Most muscles of the suture group exhibited fibrosis and scarring and adhered to the surrounding tissues. The average muscle thickness was significantly reduced to about 4 mm, average drainage was approximately 50 mL, and recovery of the wrist pronation function required approximately 4-6 weeks. The preservation group exhibited normal muscles, mild adhesions, and close to normal muscle width and thickness. The average muscle width was approximately 35 mm, average thickness was approximately 7.6 mm, average drainage was approximately 30 mL, and the wrist pronation function recovered in 2 weeks. PQ preservation was feasible, with less bleeding, faster PQ function recovery, fewer adhesions, and other advantages, and the postoperative muscle structures were close to normal. After being sutured, the PQ exhibited muscle atrophy and scarring, which might result in muscle dysfunction.