Mean Grip Strength Research Articles

Longitudinal study on the progression of muscle status among community-dwelling ambulatory older multiethnic Asians with type 2 diabetes mellitus

BackgroundMuscle health decline with age, but its deterioration in older persons with type-2 diabetes mellitus (T2DM) over time is not well-established. This study aimed to determine the change in muscle mass, handgrip strength and gait speed over time among community-dwelling ambulatory older multi-ethnic Asian patients with T2DM and their associated factors.MethodsAmong 387 eligible patients aged 60–89 years who were recruited at baseline, 348 (89.9%) were reviewed at a public primary care clinic in Singapore in the subsequent 9 to 34 months. The change in their clinical and functional status, levels of physical activity and muscle status (mass, grip strength and gait speed based on the Asian Working Group for Sarcopenia criteria) were recorded and compared. Their physical activity levels were assessed using the Physical Activity Scale for the Elderly (PASE) and International Physical Activity Questionnaire (IPAQ). Their quality of life was evaluated based on the World Health Organization Quality of Life (WHOQOL) domains. Linear regression analysis was used to identify the factors associated with muscle health change.ResultsThe study population comprised men (52.9%), Chinese (69.3%), mean age of 68.4 ± SD5.6 years and had at least secondary education (76.4%). Their mean muscle mass significantly decreased by 0.03 ± SD0.06 kg/m2/month, mean handgrip strength by 0.06 ± SD0.26 kg/month and negligible change in gait speed of 0.002 ± SD0.01 m/sec/month. Their mean weight significantly decreased by 0.5 ± SD3.9 kg, waist and hip circumferences by 2.5 ± SD6cm and 3.2 ± SD5.1 cm respectively, with no change in BMI. Linear regression shows significant associations between muscle mass change and education level (β = 0.36,p = 0.012, 95% CI = 0.08–0.64), BMI (β = 0.11,p = < 0.001, 95% CI = 0.05–0.17), change in medication class (β = 0.39,p = < 0.001, 95% CI = 0.06–0.71) and review interval (β = − 0.003, p < 0.001, 95% CI = -0.004--0.002). Gait speed change was associated with singlehood (β = − 0.13,p = 0.029, 95% CI = -0.25--0.01) and WHOQOL physical health (β = 0.01,p = 0.024, 95% CI = 0.00–0.02) domain. No factor was associated with handgrip strength change.ConclusionsThe study population with T2DM showed significant decline in their mean weight, waist and hip circumferences, mean muscle mass and mean grip strength but gait speed was unaffected. Muscle mass change was associated with education level, BMI and length of review interval. Handgrip strength change was not significantly correlated with any factor. Gait speed change was associated with singlehood and physical health.

Perilunate dislocation and fracture dislocation of the wrist: Outcomes and long-term prognostic factors

IntroductionPerilunate dislocations and fracture-dislocations are severe injuries that often have serious functional sequelae. Our goal was to evaluate the long-term clinical and radiological results of these perilunate injuries, and to look for prognostic factors of a poor clinical outcome. HypothesisAll patients who suffered perilunate injuries in their wrist have functional sequelae and long-term radiographic changes despite optimal treatment with anatomical surgical reduction. Materials and methodsWe did a single-center, retrospective study of 32 patients who had either an isolated perilunate dislocation (n=7) or fracture-dislocation (n=25) in their wrist. Pain, range of motion, strength and functional scores (MWS, PRWE, QuickDASH) were evaluated. Radiographs were analyzed to look for signs of osteoarthritis or carpal instability. ResultsThe mean follow-up time was 9.9years (3.5–24). The wrist joint had a mean flexion-extension of 86° (0–140), radioulnar deviation of 38° (0–65) and pronosupination of 153° (120–180). The mean grip strength was 35kg (5–56). The mean MWS, PRWE and QuickDASH scores were 65/100, 32/100 and 29/100, respectively. At the final assessment, 23 patients (79%) had radiographic signs of osteoarthritis while 5 patients (16%) had residual carpal instability. Three patients subsequently underwent palliative treatment. Opening the carpal tunnel and the magnitude of the lunate's displacement are significant predictors of a poor long-term functional outcome (p<0.05). Older age at the time of injury was a predictor for the development of osteoarthritis. DiscussionDespite optimal treatment, perilunate dislocations and fracture-dislocations at the wrist cause functional sequelae such as pain, stiffness, strength deficit and posttraumatic arthritis in nearly 80% of patients. The functional outcomes are determined by the amount of lunate displacement (stage) and the patient's age. We do not recommend opening the carpal tunnel, even when signs of median nerve compression are present; reducing the dislocation helps to relieve the neurological symptoms. Level of evidenceIV; retrospective observational study.

Lifetime body mass index and grip strength at age 46years: the 1970 British Cohort Study.

BackgroundOngoing rises in obesity prevalence have prompted growing concerns about potential increases in the burden of age‐related musculoskeletal conditions including sarcopenia and sarcopenic obesity. This is of particular concern for future generations of older adults who have lived more of their lives in an obesogenic environment than current generations of older adults. We aimed to study longitudinal associations between body mass index (BMI) and grip strength in midlife using data from a large population‐based sample, the 1970 British Cohort Study (BCS70).MethodsBCS70 participants with valid measures of maximum grip strength at age 46 years were included in analyses [3671 males (49%) and 3876 females (51%)]. Using sex‐specific linear regression models, we examined associations of (i) BMI at ages 10, 16, 30, and 46 years; (ii) body fat percentage (BF%) and waist–hip ratio at age 46 years; (iii) BMI gains between 10–16, 16–30, and 30–46; and (iv) age at onset of obesity, with grip strength.ResultsAt age 46 years, mean (standard deviation) grip strength was 48.10 kg (8.98) in males and 29.61 kg (5.81) in females. Higher BMI at all ages was associated with stronger grip, and the scale of associations was greater in males than females from age 16 onwards (P sex interactions < 0.01). For example, in fully adjusted models, a 1 standard deviation increase in BMI at age 16 was associated with mean differences in grip strength at age 46 years of 1.41 kg (95% confidence interval: 1.07, 1.75) in males and 0.72 kg (0.53, 0.91) in females. Higher BF% at age 46 was also associated with stronger grip in both sexes. Greater gains in BMI between ages 10 and 16 were associated with stronger grip in both sexes, but subsequent gains in BMI were only associated with stronger grip in males. Associations of greater length of exposure to obesity and stronger grip were also more consistent among males than females. For example, in fully adjusted models, mean grip strength at age 46 years of males and females who had been obese since age 10 or 16 years was 4.39 kg (1.85, 6.93) and 1.25 kg (−0.18, 2.69) higher than males and females who had never been obese, respectively.ConclusionsHigher BMI from childhood onwards is associated with stronger grip at age 46 years. This suggests that, at this age, anabolic effects of fat on muscle are outweighing the catabolic effects thought to lead to the manifestation of sarcopenic obesity later in life, especially among men. Midlife may be an optimal time to intervene to prevent sarcopenic obesity.

Post-Intensive Care COVID Survivorship Clinic: A Single-Center Experience.

OBJECTIVES:Patients discharged from the ICU post-COVID-19 pneumonitis may experience long-term morbidity related to their critical illness, the treatment for this and the ICU environment. The aim of this study was to characterize the cognitive, psychologic, and physical consequences of COVID-19 in patients admitted to the ICU and discharged alive.DESIGN:Prospective cohort study.SETTING:Post-intensive care syndrome (PICS) follow-up clinic at Tallaght University Hospital, a tertiary referral center with a 16-bed mixed medical-surgical ICU, including critical care physicians, a psychologist, a physiotherapist, and a research nurse.PATIENTS:Patients who had been admitted to the ICU in our tertiary referral center with COVID-19 pneumonitis 6 months earlier.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:A total of 22 patients attended the 6-month PICS follow-up clinic following admission to ICU with COVID-19 pneumonitis. Mean grip strength was low at the 6-month follow-up at 24.1 pounds (sd 9.8) with a minimally active median metabolic equivalent (MET) of 970 METs/wk (interquartile range, 0–7,794 METs/wk). Only 59% of patients were independent with regard to their activities of daily living. Eight of 14 patients (57%) had returned to work by 6 months post-ICU discharge. Their mean Intensive Care Psychological Assessment Tool (IPAT) score was 6.6 (sd 4.6) with a Post-Traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders-5th Edition (PCL-5) score of 21.1 (sd 17.5) and a mean Montreal Cognitive Assessment (MoCA) score of 24 (sd 8.4); suggestive of mild cognitive impairment. In a multivariable regression model, only Acute Physiology and Chronic Health Evaluation II score was significantly independently associated with MoCA score as a cognitive PICS outcome (beta-coefficient, –1.6; se, 0.6; p = 0.04). None of the predictor variables were significantly independently associated with IPAT and PCL-5 as psychologic outcomes, nor with International Physical Activity Questionnaire-Short Form as a physical PICS outcome.CONCLUSIONS:In this single-center prospective cohort study, we found that patients have a high burden of physical and psychologic impairment at 6 months following ICU discharge post-COVID-19 pneumonitis; in many cases requiring specialist referrals for long-term input. We advocate for increased resources for this much needed follow-up multidisciplinary intervention for an ever-growing population of patients.

Clinical outcome of percutaneous common extensor tenotomy for recalcitrant lateral humeral epicondylitis

Introduction: Tennis elbow is a commonly encountered problem in orthopaedic clinical practice. The patients are usually in their financially productive years and many a times, this is a work related disorder that becomes severe enough leading for lost work days. Conservative treatment is almost always the first choice; but once it fails, there is no clear consensus for the management of recalcitrant cases. We undertook this study to evaluate the clinical outcomes of percutaneous tenotomy in cases of resistant lateral epicondylitis. Materials and methods: This was a prospective study done over a period of 5 years. A total of 108 patients with recalcitrant tennis elbow were recruited and underwent percutaneous tenotomy. They were followed up for an average period of 14 months. The outcomes measured were: tenderness, DASH score, Roles & Maudsley scale, Visual analogue scale (VAS), and Grip strength. Statistical analysis was done using Paired t-test. Results: 95% patients were pain free after an average of 12 weeks. The 6 months postoperative improvement in VAS score was 6.84 and change in mean DASH score was 23.04. The average increase in mean grip strength was 13.30 kg. These results were statistically significant. Conclusion: Percutaneous tenotomy can be considered as a useful treatment option for resistant cases of tennis elbow.

Mid-term Outcomes of Treatment of Fracture Dislocation of the Proximal Interphalangeal Joint with Gexfinger®–A New Dynamic External Fixator

Background: Fracture dislocations of the proximal interphalangeal joint (PIPJ) are challenging injuries and a dynamic external fixator frame is often used. We devised a dynamic external fixator device called the Gexfinger® that allows greater control of the degree of traction. The aim of this study is to report the mid-term outcomes of this device. Methods: This is a retrospective study of patients with fracture dislocation of the PIPJ who were treated with the Gexfinger® over a 3-year period. Clinical data with regard to the patient, the injury, treatment and period of follow-up were recorded. The outcome measures included time to return to work, arc of motion at the interphalangeal joints, grip strength, visual analogue score (VAS) for pain, patient satisfaction and complications. Results: We studied 26 patients (17 men and 9 women) with an average age of 38 years. The average articular surface involvement was 56%. The mean period between injury and surgery was 6 days and the frames were maintained for 5.5 weeks on average. The mean follow-up period was 8.5 weeks. All patients returned to work at an average of 7 weeks. The mean arc of motion at the PIPJ and distal interphalangeal joint (DIPJ) were 82° and 65°, respectively and the mean grip strength was 83% of the contralateral side. 22 patients reported no pain at the final follow-up. Fifteen patients were very satisfied, 8 satisfied and 3 unsatisfied. Two patients had stiffness of the PIPJ. Conclusions: The mid-term outcomes of the Gexfinger® are similar to other methods of dynamic traction described in literature. It is modular, easy to assemble and allows a greater control of the degree of traction. In combination with additional screws and/or K-wires, it has allowed us to treat a wide spectrum of PIPJ fracture dislocations with good outcomes. Level of Evidence: Level IV (Therapeutic).

Reconstruction of scaphoid waist non-unions using a radial approach: Preliminary outcome analyses

This study aimed to evaluate clinical and radiographic outcomes in a consecutive series of patients who underwent open surgery via a radial approach for reconstruction of scaphoid waist non-union. Over a 2-year period, 16 males with scaphoid waist non-union received surgery using a radial approach; we performed limited styloidectomy, biconcave curettage, ovoid bone grafting from the styloidectomy fragment, and placement of a retrograde radial-entry screw. Mean patient age was 25.1 years (range 17–56 years). Bony union was determined on radiographs and computed tomography. Radiographic variables were measured on preoperative and final follow-up radiographs. Mean follow-up was 14 months (range 8–19 months). Subjective and objective outcomes were recorded. Radiographic healing was achieved in 14 of the 16 patients (88%) at a mean 4½ months after surgery (range 3–6 months). Significant postoperative improvements were found in mean carpal height ratio (from 0.48 to 0.53) and radiolunate angle (from 8.2° to 2.8°) compared to preoperative data. Mean postoperative wrist extension was 54° (range 32–67°) and mean flexion 49° (range 2–64°). Mean flexion arc after surgery was 84.1% that of the contralateral side. Mean grip strength was 85.2% that of the contralateral side. Subjective results comprised mean postoperative Modified Mayo Wrist score of 82.3 (range 55–90) and Quick Disabilities of the Arm, Shoulder and Hand score of 11.2 (range 0–36.4). Twelve of the 14 healed wrists were subjectively rated as good or excellent. Repair of scaphoid non-union via a radial approach was safe and effective. Union rates were high and outcomes were good.

Treatment of isolated fourth metacarpal neck fractures using the closed reduction and percutaneous intermetacarpal and external fixation

BackgroundThe isolated fourth metacarpal neck fracture is uncommon, and the appropriate management is still debatable. The aim of this retrospective study was to introduce a closed reduction and percutaneously intermetacarpal K-wire fixation external technique to treat the isolated fourth metacarpal neck fracture. MethodsFrom October 2013 to January 2018, 21 patients with closed-isolated fourth metacarpal neck fractures (angulation ≥35°, rotation ≥5°, or shortening ≥5 mm) were treated with the closed reduction and percutaneous intermetacarpal and external fixation technique. Total active motion, grip strength of the hand, dorsal prominence, and patient satisfaction were assessed. ResultsFollow-up lasted 28 months (range, 24–37 months). All patients obtained bone healing at a mean time of 5 weeks (range, 4–8 weeks). External fixation devices were removed when bone healing achieved. The mean total active motion reached 97.5% (range, 92.9%–100%) of opposite side. There were 18 excellent and 3 good results. The mean grip strength reached 98.4% (range, 96.2%–100%) of the opposite hands. Based on the 100-mm visual analogue scale, the mean dorsal prominence was 0 (range, 0 to 1). Based on the Short Assessment of Patient Satisfaction, the mean satisfaction score was 26 (range, 24 to 28). ConclusionsThe closed reduction and percutaneous intermetacarpal and external fixation technique is useful and reliable for treating the isolated fourth metacarpal neck fracture. The technique can effectively restore the fracture deformities and maintain the reduction stably, resulting in good hand function. Level of evidenceTherapeutic study, Level IV.

FUNCTIONAL OUTCOME OF TREATING GIANT CELL TUMOUR OF DISTAL ULNA WITH WIDE EXCISION AND WRIST RECONSTRUCTION WITH ILIAC CREST BONE GRAFT

Background: Giant cell tumours of bone are aggressive, potentially malignant lesions. Juxta articular giant cell tumours of lower end ulna are rare and present a special problem of reconstruction after tumour excision. Out of the various treatment procedures described, use of iliac crest bone graft for wrist reconstruction after wide resection of the tumour is done with satisfactory functional results. Methods: Six patients with a mean age of 21 years, with proven giant cell tumours of distal end ulna were treated with wide excision and reconstruction with tricortical iliac crest graft. Wrist reconstruction and xation of graft was done with 4.o mm cancellous screws and K wire. The distal stump of resected ulna was stabilised by Extensor carpi ulnaris tendon slip. Results: The follow up ranges from 3 years (mean 30 months). At last, follow up, the mean MSTS was 71 and mean grip strength improved from 28 kg. to 37 kg. with an attainment of mean grip strength of 80% as compared with the contra lateral hand and a fair range of movements. There was no incidence of recurrence, any malignant transformation, loss of function, neurovascular decit. There were no cases with any infection or wound dehiscence. Conclusions: Distal ulna can be replaced with xation iliac crest bone graft provided it is attached to the triangular bro cartilage and ulnar collateral ligament which results in restoration of the anatomy and stability of distal radioulnar joint respectively. The distal resected stump of the ulna should be stabilised with ECU by tenodesis to prevent impingement which gave a good result in our cases.

Clinical results of a 10-year follow-up of surgical treatment for elbow stiffness in rheumatoid arthritis: A case series

BackgroundRheumatoid arthritis commonly causes transient limitation of joint motion, but the treatment of persistent stiffness in the rheumatoid elbow has rarely been reported. The purpose of this study was to evaluate the long-term clinical results of surgical treatment of rheumatoid elbow stiffness. MethodsSurgical treatment, including open arthrolysis with hinged external fixation, total synovectomy, and ulnar nerve release and anteriorization, was performed in 48 elbows in 43 patients with rheumatoid arthritis and early joint destruction. Mobility (flexion-extension and pronation-supination), Mayo Elbow Performance Score (MEPS), visual analog scale (VAS) score, muscle strength, nerve symptoms, postoperative complications, and recurrent synovitis were evaluated 9–11 years (average, 9.88 years) postoperatively. ResultsThe mobility of the elbow was significantly improved over the preoperative period either in extension, flexion, protonation, supination (P < .001, P < .001, P < .001, P = .002). The mean MEPS was significantly improved from 56.25 points (range, 30–90) to 87.40 points (range, 40–100) (P < .001). The pain was relieved, and the mean VAS score was reduced from 3.56 (range, 0–8) to 1.08 (range, 0–5) points (P < .001). Preoperative ulnar nerve symptoms were observed in 17 patients and relieved in 10 (59%) patients, and the mean Amadio score was raised from 6.9 (range, 3–9) to 7.96 (range, 4–9) points (P < .001). Through surgical treatment and postoperative rehabilitation, the mean grip strength of the patients was significantly improved from an average of 9.01 (range, 3.4–18.5) to 17.56 kg (range, 3.9–40.2) (P < .001). Five elbows developed recurrent synovitis, and one underwent total elbow arthroplasty. Postoperative complications were uncommon and not severe. ConclusionSurgical treatment is a reliable procedure for rheumatoid elbow stiffness and can be effective in improving elbow mobility, function, muscle strength, pain relief, and relief of nerve symptoms.

Effects of Core Decompression and Local Deferoxamine Injection on Clinical Outcomes and Revascularization of Lunate Carpal Bone in Kienböck‎ Disease: A Pilot Study

Background: Avascular necrosis of the lunate or Kienböck‎ disease is a rare disorder with unknown etiology and challenging treatment. Objectives: In this study, we evaluated the effects of local deferoxamine injection as an angiogenic molecule and core decompression to treat Kienböck‎ disease. Methods: In a pilot clinical trial, 8 patients with stage I to IIIA of Kienböck‎ disease were treated with core decompression and local deferoxamine injection (0.5 mL 500 mg/mL). The outcome measures included wrist range of motions, pinch and grip strength, patient-rated ‎wrist/hand evaluation (PRWE), a short form of disabilities of the arm, shoulder, and hand (Quick-DASH), and visual analog scale (VAS) for pain. The assessment of lunate revascularization was also done by T1- and T2-weighted magnetic resonance imaging. All measurements were done before the intervention and 3, 6, and 12 months after the intervention. Results: Wrist flexion, extension, ulnar and ‎radial deviation, and pinch and grip strength were continuously improved over the postoperative periods. These improvements were statistically significant. The mean final pinch and grip strength averaged 87.4% and 72.8% of the non-involved hand, respectively. PRWE, Quick-DASH, and VAS scores were also continuously and significantly improved over the study period. The lunate vascularization revealed a continuous improvement in 6(75%) patients. Conclusion: Local deferoxamine injection in addition to core decompression could improve the radiologic and clinical outcomes of patients suffering from Kienböck‎ disease.

Outcomes of ulna shortening osteotomy: a cohort analysis of 106 patients

BackgroundUlna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology.Materials and methodsWe report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool.ResultsThe PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen’s d = −1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion.ConclusionWe found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO.Level of evidenceTherapeutic III.

The Effect of Electromagnetic Field of Mobile Phone on Hand Grip and Shoulder Strengths

Aim: The aim of this study was to evaluate the relationship between holding a mobile phone in the non-dominant hand and the hand grip, the shoulder abduction and flexion strengths on the dominant hand side. Materials and Methods: This is an observational study. The study was conducted between November 15, 2019 - November 29, 2019 in 61 adults aged 18-30 years in Izmir, Turkey. Three repeated measurements of hand grip strength, shoulder abduction and shoulder flexion strength in dominant hand / on the shoulder of the dominant hand were compared. Measurements were as follows: In the non-dominant hand when there is no mobile phone (Measurement 1); In the non-dominant hand when there is a switched off mobile phone in (Measurement 2); In the non-dominant hand when there is a mobile phone on in standby mode (Measurement 3). In statistical analysis, student t test and one way or two-way analysis of variance were used for repeated measurements. A p value of ≤0.05 was considered statistically significant. Results: There was no significant difference between the first, second and third measurement results in terms of mean grip strength (for each one p>0.05). However, the mean values of shoulder abduction strength and shoulder flexion strength were lower in the third measurements compared to the first measurements (for each one p ≤0.05). Conclusion: There is evidence that the contact with the mobile phone in the nondominant hand will cause an acute decrease in muscle strength, especially in the shoulder girdle. Further studies in large populations on the subject of this study are recommended.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76° and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

Outcomes of Arthroscopic Scaphoid Excision and Lunocapitate Fusion for Advanced Traumatic Arthritis of the Wrist.

Arthroscopic lunocapitate (LC) fusion can be an alternative surgical treatment for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist. We retrospectively reviewed patients who had arthroscopic LC fusion to estimate clinical and radiological outcomes. From January 2013 to February 2017, all patients with SLAC (stage II or III) or SNAC (stage II or III) wrists, who underwent arthroscopic LC fusion with scaphoidectomy and were followed up for a minimum of 2 years, were enrolled in this retrospective study. Clinical outcomes included visual analog scale (VAS) pain, grip strength, active range of wrist motion, Mayo wrist score (MWS), and the Disabilities of Arm, Shoulder and Hand (DASH) score. Radiologic outcomes included bony union, carpal height ratio, joint space height ratio, and loosening of screws. We also performed group analysis between patients with 1 and 2 headless compression screws to fix the LC interval. Eleven patients were assessed for 32.6 ± 8.0 months. Union was achieved in 10 patients (union rate, 90.9%). There was improvmenet in mean VAS pain score (from 7.9 ± 1.0 to 1.6 ± 0.7, p = 0.003) and grip strength (from 67.5% ± 11.4% to 81.8% ± 8.0%, p = 0.003) postoperatively. The mean MWS and DASH score were 40.9 ± 13.8 and 38.3 ± 8.2, respectively, preoperatively and improved to 75.5 ± 8.2 and 11.3 ± 4.1, respectively, postoperatively (p < 0.001 for all). Radiolucent screw loosening occurred in 3 patients (27.3%), including 1 nonunion patient and 1 patient who underwent screw removal due to the screw migration encroaching the lunate fossa of radius. In group analysis, only the frequency of radiolucent loosening was higher in 1 screw (3 of 4) than 2 screw fixation (0 of 7) (p = 0.024). Arthroscopic scaphoid excision and LC fusion for patients with advanced SLAC or SNAC of the wrist was effective and safe only in cases fixed with 2 headless compression screws. We recommend arthroscopic LC fusion using 2 screws rather than 1 to decrease radiolucent loosening, which might affect complications such as nonunion, delayed union, or screw migration.

Comparision between functional outcome of scaphoid fracture treated by open reduction internal fixation vs percutaneous fixation

Scaphoid bone fracture is one of the commonest carpal bone fractures. It is predominantly seen in young population. Unstable or displaced scaphoid fractures can be treated either by primary use of cast immobilization alone, by use of Open Reduction Internal Fixation (ORIF) technique or by percutaneous fixation with Herbert screw under direct C arm fluoroscopic guidance. This study aims to review clinical, radiological and function outcome following ORIF technique Vs Percutaneous Fixation Technique in scaphoid fractures.Cases of acute scaphoid fractures who came to our department and met inclusion and exclusion criterias were identified and included in this study. Clinical details of these patients were obtained and scaphoid radiographs were taken. Injuries were graded as per Herbert and Fisher Classification. All our cases underwent grip-strengthening exercises and relevant physiotherapy Clinico-radiological details of our cases were obtained at each follow-up. Final follow-up of our cases was performed using Modified Mayo Wrist Score (MMWS). Grip strength was graded as per Medical Research Council (MRC) scale and range of motion was assessed using goniometer.A total of 40 cases were enrolled in our study. 16 patients (40% cases) underwent percutaneous herbert screw fixation and rest of our cases underwent open reduction and internal fixation. Radiological union in cases treated with percutaneous fixation was faster as compared to cases treated by ORIF. Also patients treated with percutaneous method demonstrated higher mean range of motion score, mean grip strength score and activity score.In our study excellent results have been obtained in cases treated with percutaneous approach in terms of post-operative morbidity and this approach also allows earlier return to sports and work thereby necessitating importance of this approach over ORIF approach in a developing resource poor country like India.

A Randomized Trial Assessing the Muscle Strength and Range of Motion in Elderly Patients following Distal Radius Fractures Treated with 4- and 6-Week Cast Immobilization.

Background: There is no consensus among orthopedic surgeons as to the required period of cast immobilization in distal radius fractures in elderly patients. The purpose of this study was to assess muscle strength and range of motion symmetry in elderly patients after distal radius fractures with different periods of cast immobilization. Methods: This study evaluated 50 patients (33 women and 17 men), aged over 65 years, after cast immobilization treatment for distal radius fracture. The mean age at the beginning of treatment was 71 years. The mean duration of follow-up was 1 year and 3 months. The first subgroup (n = 24) comprised the patients whose fractures had been immobilized in a cast for 6 weeks, another subgroup (n = 26) comprised the patients with 4-week cast immobilization. We assessed: (1) muscle strength, (2) range of motion. Results: The mean grip strength in the treated limb was 71% and 81% of that in the healthy limb in the groups with 4-week and 6-week cast immobilization, respectively (p = 0.0432). The study groups showed no differences in the mean grip strength in the treated limbs or the mean grip strength in the healthy limbs. The mean treated limb flexion was 62° and 75° in the 4-week and 6-week immobilization groups, respectively (p = 0.025). The evaluated groups showed no differences in terms of any other range of motion parameters. The grip strength and range of motion values were significantly lower in the treated limb than in the healthy limb in both evaluated groups. Only the values of wrist radial deviation in the 6-week cast immobilization group showed no differences between the treated and healthy limbs. Conclusion: Higher values of injured limb muscle strength and greater mean range of wrist flexion were achieved in the 6-week subgroup. Neither of the evaluated groups achieved a symmetry of muscle strength or range of motion after treatment. Full limb function did not return in any of the elderly distal radius fracture patients irrespective of cast immobilization duration.

Clinical and radiological results of distal radioulnar joint arthroplasty with the Aptis prosthesis.

We report the results of the treatment of disorders of the distal radioulnar joint with the semi-constrained Aptis prosthesis. Nineteen patients were assessed at a mean follow-up of 7 years. All patients had been operated on previously at the wrist, forearm or elbow. The Disabilities of Arm, Shoulder and Hand score had a mean value of 40, the Patient-Rated Wrist Evaluation score had a mean of 49 and the visual analogue scale for pain had a mean of 3.9. The mean ranges of pronation, supination, wrist flexion and wrist extension were 78°, 76°, 60° and 51°, respectively. The mean grip strength was 23 kg. Complications were noted in ten patients. Eighteen patients would undergo the operation again. The 10-year cumulative survival rate was 84%. The Aptis prosthesis may be a solution to treat patients in whom previous surgery at the distal radioulnar joint has failed.Level of evidence: IV.

Scaphoidectomy and 4-corner arthrodesis with headless compression screws: results, complications and their treatment.

Scaphoidectomy and 4-corner arthrodesis is a common salvage surgery for degenerative wrist pathology. The purpose of this study was to evaluate the results of this procedure performed with headless compression screws, with a special focus on postoperative complications and their treatment. We assessed 36 wrists in 31 patients that were treated between 2009 and 2017. Mean follow-up was 5.2 years (range 2.9- 9.4). Pain was expressed on a Visual Analog Scale. The Quick Disabilities of the Arm, Shoulder and hand (qDASH) questionnaire and Michigan Hand Outcome Questionnaire (MHOQ) were used to assess patient functionality and satisfaction. Range of motion and grip strength of both wrists were measured. Radiographs of the operated wrist were evaluated. Mean pain score was 1.5 ± 2.3 with 19% of patients being completely free of pain also during activity. Mean qDASH was 44 ± 20 and mean MHOQ was 10 ± 5. Mean flexion-extension arc of the operated wrist was 69° and 61% of the contralateral wrist. Mean grip strength was 35kg and 89% of the opposite wrist. Non-union was observed in two patients. Two patients required hardware removal and in three patients a pisiformectomy was performed. Conversion to total wrist arthrodesis was needed in one patient. We observed postoperative complications in 28% of our patients. Most complications can successfully be treated with additional surgery. The presence of pisotriquetral arthritis should be assessed before surgery and treated with pisiform excision.

Normative Static Grip Strength of Saudi Arabia's Population and Influences of Numerous Factors on Grip Strength.

Most daily tasks require exerting static grip strength which can be challenging for the elderly as their strength diminishes with age. Moreover, normative static grip strength data are important in ergonomics and clinical settings. The goal of this study is to present the gender, age-specific, hand-specific, and body-mass-index-specific handgrip strength reference of Saudi males and females in order to describe the population’s occupational demand and to compare them with the international standards. The secondary objective is to investigate the effects of gender, age group, hand area, and body mass index on the grip strength. A sample of 297 (146 male and 151 female) volunteers aged between 18 and 70 with different occupations participated in the study. Grip strength data were collected using a Jamar dynamometer with standard test position, protocol, and instructions. The mean maximum voluntary grip strength values for males were 38.71 kg and 22.01 kg, respectively. There was a curvilinear relationship of grip strength to age; significant differences between genders, hand area, and some age groups; and a correlation to hand dimensions depending on the gender.