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

Traumatic osteoarthritis of the wrist is a disabling disease that affects middleaged active adults in the prime of their working life. I set out to assess wrist function and disability in patients with traumatic wrist osteoarthritis before and after surgery. I measured wrist range of motion with flexible electrogoniometer, grip strength with force-time curves using dynamometer, hand function with timed Sollerman hand function test and patient-reported outcome. I first developed these techniques in normal volunteers and then extended them to patients with wrist osteoarthritis before surgery and after four-corner fusion, three-corner fusion, total wrist fusion, and proximal row carpectomy. I used flexible electrogoniometry to generate circumduction curves to measure range, rate and rhythm of circumduction of the wrist. It showed that there was no difference in range of motion parameters in patients with wrist osteoarthritis before surgery and after four-corner fusion and three-corner fusion. Proximal row carpectomy provides better flexion-extension and poorer radio-ulnar deviation than four-corner fusion. Three-corner fusion allows better rate and rhythm of movements in flexion and ulnar deviation compared to four-corner fusion. Grip strength was measured with dynamometer to generate force time curves to measure sustainability of grip. There was no difference between our groups with wrist osteoarthritis before surgery and after wrist fusion, four-corner fusion or three-corner fusion. I developed the Timed Sollerman hand function test by measuring the time taken to complete each of the tasks without summarisation into a 5-point scale. It showed that volunteers completed the tasks quicker with the dominant hand than with the nondominant hand. Women took less time to complete the tasks in the 30-40 years age group than women in the 20-30 years age group and beyond 40 years. The patients with PRC completed the different activities of daily living quicker than the 4CF patients, except for activities requiring wrist torque strength.