Wrist partial arthrodesis or other motion preserving surgery for degenerative wrist disease: Prospective comparative assessment of grip strength, range of motion, function and disability.

摘要

Traumatic osteoarthritis of the wrist is a disabling disease that affects middleaged\udactive adults in the prime of their working life. I set out to assess wrist\udfunction and disability in patients with traumatic wrist osteoarthritis before and\udafter surgery. I measured wrist range of motion with flexible\udelectrogoniometer, grip strength with force-time curves using dynamometer,\udhand function with timed Sollerman hand function test and patient-reported\udoutcome. I first developed these techniques in normal volunteers and then\udextended them to patients with wrist osteoarthritis before surgery and after\udfour-corner fusion, three-corner fusion, total wrist fusion, and proximal row\udcarpectomy.\udI used flexible electrogoniometry to generate circumduction curves to\udmeasure range, rate and rhythm of circumduction of the wrist. It showed that\udthere was no difference in range of motion parameters in patients with wrist\udosteoarthritis before surgery and after four-corner fusion and three-corner\udfusion. Proximal row carpectomy provides better flexion-extension and poorer\udradio-ulnar deviation than four-corner fusion. Three-corner fusion allows better\udrate and rhythm of movements in flexion and ulnar deviation compared to\udfour-corner fusion.\udGrip strength was measured with dynamometer to generate force time curves\udto measure sustainability of grip. There was no difference between our groups\udwith wrist osteoarthritis before surgery and after wrist fusion, four-corner\udfusion or three-corner fusion.\udI developed the Timed Sollerman hand function test by measuring the time\udtaken to complete each of the tasks without summarisation into a 5-point\udscale. It showed that volunteers completed the tasks quicker with the\uddominant hand than with the nondominant hand. Women took less time to\udcomplete the tasks in the 30-40 years age group than women in the 20-30\udyears age group and beyond 40 years. The patients with PRC completed the\uddifferent activities of daily living quicker than the 4CF patients, except for\udactivities requiring wrist torque strength.