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Predicting Pinch Strength Following LRTI of the First Carpometacarpal Joint
Joshua Abzug, MD; University of Maryland; Abdo Bachoura, MD; Philadelphia Hand Center; Ebrahim Paryavi, MD; University of Maryland School of Medicine; Sidney M. Jacoby, MD; Thomas Jefferson University; A. Lee Osterman, MD; Thomas Jefferson University Hospital - The Philadelphia Hand Center

Introduction: The extent of first metacarpal subsidence following ligament reconstruction and tendon interposition arthroplasty (LRTI) has been implicated as a possible cause of weak pinch. The purpose of this study was to determine the predictors of pinch strength following LRTI.

Materials & Methods: Between 1/1/2009 and 12/31/2010 all LRTI cases for one surgeon were retrospectively reviewed. Our outcome of interest was postoperative key pinch strength at final follow-up. Bivariate and multivariate linear regression analyses were used to investigate the relationship between final key pinch strength and various patient characteristics and radiographic parameters. These factors included 1) gender 2) preoperative key pinch strength; 3) Eaton-Lambert arthritis stage; 4) age; 5) the number of days after surgery; 6) first metacarpal subsidence as gauged by increasing vertical distance between the bases of the first and second metacarpals on AP X-rays; 7) first metacarpal subsidence as gauged by decreasing distance between the first metacarpal and the distal pole of the scaphoid on AP x-rays.

Results: Twenty-seven patients met inclusion criteria. The mean age was 63.6 (range 48-79 years). There were 9 males and 18 females. The mean pinch strength was 10 (2-26 psi) preoperatively and 8 (2-22psi) postoperatively. Pinch strength was recorded at a mean of 52 days preoperatively. The mean follow up duration was 8 (2-27 months). In bivariate analysis, only preoperative pinch strength was found to correlate with postoperative pinch strength, R=0.556, p=0.003. A final multivariate model demonstrated an increase in mean pinch strength of 0.54psi (95% CI 0.014, 0.93) per millimeter increase in vertical distance between the bases of the first and second metacarpals on AP xray as well 0.48psi greater mean key pinch strength per 1psi higher pre-operative pinch strength (95% CI 0.24, 0.69).

Conclusion: Increased subsidence does not negatively predict postoperative pinch strength. The most predictive parameter of postoperative pinch strength is preoperative pinch strength.

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