The Journal of Bone and Joint Surgery (American). 2008;90:2408-2415.
doi:10.2106/JBJS.F.00577
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Hand Function and Activity Performance of Children with Longitudinal Radial Deficiency

Laurien M. Buffart, MSc1, Marij E. Roebroeck, PhD1, Wim G.M. Janssen, MD1, Anneke Hoekstra, PT1, Ruud W. Selles, PhD1, Steven E.R. Hovius, MD, PhD1 and Henk J. Stam, MD, PhD, FRCP1

1 Departments of Rehabilitation Medicine (L.M.B., M.E.R., W.G.M.J., A.H., R.W.S., and H.J.S.) and Plastic and Reconstructive Surgery (R.W.S. and S.E.R.H.), Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail address for L.M. Buffart: l.buffart{at}erasmusmc.nl

Investigation performed at the Departments of Rehabilitation Medicine and Plastic and Reconstructive Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Johanna Children's Fund and the Children's Fund Adriaanstichting. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: The effects of treatment of children with longitudinal radial deficiency are generally evaluated by measuring grip and pinch strength and joint mobility. Insight into limitations of activities of children with radial deficiency is scarce. In this study, we used standardized instruments to assess impairments in hand function and activity limitations and explored the relationship between the two.

Methods: We evaluated the hand function of twenty children with radial deficiency who were between four and twelve years of age. Impairments in hand function were assessed by measuring grip and pinch strength and the active range of motion of the wrist and of the metacarpophalangeal and proximal interphalangeal joints of the second digit. Functional activities were assessed with use of the Assisting Hand Assessment (AHA), to measure the effectiveness of the affected hand, and the Prosthetic Upper Extremity Functional Index (PUFI), to evaluate the ease of activity performance. The relationship between hand function and activity performance and the relationship of those measures with the type of radial deficiency were determined.

Results: The average grip and pinch strengths were 36% and 30% of reference values. We found reductions in the active range of motion, particularly of the metacarpophalangeal and proximal interphalangeal joints. The mean AHA score was 85.5 points and the mean PUFI score was 81.8 points, with both measured on a 0 to 100-point scale. Grip and pinch strength, the active range of joint motion, and the sum scores on the two functional tests were related to the type of radial deficiency. Significant relationships were found between impairments in hand function and activity performance. There was a large variation in the activity performance of the children with poor strength, whereas a more linear relationship was found between the active ranges of motion of the wrist and finger joints and activity performance.

Conclusions: Despite marked impairments in hand function, children with radial deficiency performed functional activities fairly well. Relationships between impairments in hand function and limitation of activities were not linear. We recommend that evaluations of the results of treatment include assessment of both aspects of hand function.


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