Grip strength following total wrist arthrodesis using the same hand as reference: a prospective study

A Prospective Study

Keywords wrist, fusion, grip strength, arthritis

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

Author Biographies

O Koch, University of Pretoria

MBChB(UP), MMed(Orth)UP, FC Orth SA; 1 Military Hospital, Department of Orthopaedic Surgery, University of Pretoria and Pretoria East Hospital, South Africa

A N Alexander, University of Pretoria

MBChB(UP), FC Orth SA; Kalafong Hospital, Department of Orthopaedic Surgery, University of Pretoria, South Africa

S Olorunju, South African Medical Research Council

PhD; Biostatistics Unit, South African Medical Research Council, South Africa

H A McLoughlin, Pretoria East Hospital

D Litt et Phil; Pretoria East Hospital, South Africa

T L Le Roux, University of Pretoria

MBChB(UP), MMed(Orth)UP FCS Ort SA; 1 Military Hospital, Department of Orthopaedic Surgery, University of Pretoria; Pretoria East Hospital, South Africa

Published
2019-09-05
How to Cite
KOCH, O et al. Grip strength following total wrist arthrodesis using the same hand as reference: a prospective study. South African Orthopaedic Journal, [S.l.], p. 41-45, sep. 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/307>. Date accessed: 14 dec. 2019.

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