Abstract
Introduction: Many patients suffer from a decrease in grip strength due to various conditions of the wrist, including osteoarthritis. A stable painless wrist is essential for normal function of the hand. Many patients are offered a total wrist fusion to alleviate their pain and increase their grip. There is a dearth of literature investigating the effect of total wrist arthrodesis on grip strength utilising the same side as a reference. Methods: A prospective study was done to determine change in grip strength and patient-reported outcome measurements postoperatively as compared to same-side pre-operative values in subjects undergoing total wrist arthrodesis with a minimum follow-up of one year. Grip strength was measured pre-operatively and at least one year post-operatively using the Jamar® (Patterson Medical) dynamometer in the standardised method as part of set protocol. Functional outcomes were assessed by the patients completing Disabilities of Arm, Shoulder and Hand (DASH) scores, pre-operatively and at one-year follow-up. The differences in measures were assessed using a paired samples T-test, as well as percentage changes between measurements. Results: Twenty-two patients were evaluated, with a mean age of 49.6 years (range 19–85). The mean follow-up was 27 months (12–52 months). The grip strength in the affected hand improved on average by 12.6 kg (p<0.001; CI 95% [7.7, 17.3]). The grip in the affected hand was 84.5% compared to the pre-operative value of the unaffected side (32.8 kg vs 38.8 kg; p<0.001). The DASH score improved by 27.8 points (p=0.1). Conclusion: Total wrist fusion remains a reliable procedure to restore a power grip at the expense of wrist movement. It is a suitable option for a high-demand patient with an isolated wrist problem. Level of evidence: Level 3
Highlights
Many patients suffer from a decrease in grip strength due to various conditions of the wrist, including osteoarthritis
Rauhaniemi et al.[2] published research where post-operative grip strength was measured as a percentage of the pre-operative value in 115 patients with rheumatoid arthritis following a total wrist arthrodesis
Twenty-five participants undergoing a total wrist fusion for osteoarthritic-related conditions from August 2013 to the current date were eligible for the study provided they could comply with a one-year minimum follow-up post-operatively
Summary
Many patients suffer from a decrease in grip strength due to various conditions of the wrist, including osteoarthritis. Methods: A prospective study was done to determine change in grip strength and patient-reported outcome measurements postoperatively as compared to same-side pre-operative values in subjects undergoing total wrist arthrodesis with a minimum follow-up of one year. Rauhaniemi et al.[2] published research where post-operative grip strength was measured as a percentage of the pre-operative value in 115 patients with rheumatoid arthritis following a total wrist arthrodesis. This study used the Mannerfelt technique.[3] Right-hand grip strength was 24% stronger after one year, and 20% stronger if surgery was on the left hand This is the most extensive series reported in the literature. A study similar to the current paper retrospectively reviewed the gain in grip strength in 39 cases and reported the pre-operative grip in the affected hand as 21 kg on average and 31 kg post-operatively (Meads et al.[4]). The study objectives were to determine: 1. The gain in grip strength in the same hand as a percentage of the value pre-operatively
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