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

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.