Evaluation of Handgrip Strength Loss In Patients With Intra-articular Distal End Radius Fracture Frykman III to VIII At 1 Year Post Trauma

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Date
2011
Authors
CHONG, KHENG LING
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Pusat Pengajian Sains Perubatan Universiti Sains Malaysia
Abstract
Introduction Distal radius fractures (DRFs) are one of the commonest orthopaedic fractures seen and treated at hospitals with significant economic and morbidity impact on both the patients and the society. The treatment options for DRFs either conservatively or surgically depend on the severity of fractures, fracture patterns, age group and also the surgeon’s preferences. Advancement in surgical treatments allows stable fixation of the fractures and facilitate early rehabilitation of the affected upper limb. The outcome of DRF treatments can be assessed either using a subjective, objective or radiological outcome assessment with each has its own advantages and weaknesses. This study assessed the objective outcome of intra-articular DRFs that were treated surgically at 1 year post-trauma using handgrip strength of the affected limb in comparison to the contralateral normal limb as the parameter for the assessment. Objective The main objective of this study was to determine whether there was any handgrip weakness after 1 year post trauma in patients with DRFs that were treated surgically by comparing the affected upper limb with the contralateral normal upper limb. The minor objectives of the study were to determine whether any handgrip strength loss were influenced by other factors such as hand dominancy, nature of patients’ occupation as in hard labour or light labour or the severities of fracture based on Frykman classification. Methods 90 patients aged between 18 to 60 years old who had DRFs and treated surgically at least 1 year ago were selected from the patient databases of Hospital USM and Hospital Pulau Pinang. The patients were screened according to the pre-determined inclusion and exclusion criteria by going through the case notes and interviews at the clinic. The patient’s last radiographs taken at clinic follow-up prior to discharge were evaluated and the severity of the fractures was classified according to the Frykman’s classification. Written consents were taken from the selected patients before proceeding with their handgrip strength measurements using the Jamar Hand Dynamometer for three times with five seconds interval of rest in between attempts. The mean of the measured handgrip strength were adjusted according to the hand dominancy and then compared to the normal hand. The percentages of handgrip strength loss of the injured hand were used to determine if other factors such as age, gender, type of occupations and dominancy of the injured limb have any influence on the amount of strength loss. The data were analyzed using the IBM® Social Science and Statistical Packaged (SPSS) software. Results and conclusion 95.6% of the patients in the study had statistically significant handgrip strength loss after 1 year post-trauma despite completed at least 3 months of physiotherapy with p<0.00. The mean percentage of handgrip strength loss was 31.25% at the injured hand. 38.9% of the patients had injury to their dominant hands although percentage of handgrip strength loss was not influenced by hand dominancy of the injured site (p=0.076). The percentages of handgrip strength loss was found to have significant relationship (p=0.022) with severity of the fractures with lower percentages of strength loss in those with least severe fractures and higher percentages of strength loss in those with more severe fractures. There were no significant relationship between the percentages of handgrip strength loss with age group (p=0.146), gender (p=0.309) and the types of occupations that the patients engaged in (p=0.637).
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Orthopaedic
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