Optimal Forearm Position Allowing Maximum Hand Function: A Quasi-experimental Study in Adolescent Children

The aim of this study was to determine the ideal forearm position that allows maximum upper-limb function. In certain congenital/acquired upper-limb disorders, the management boils down to sacrificing rotatory movements of the forearm. The position of fusion that facilitates maximum upper-limb function is a topic of debate and is decided upon by personal preferences and assumptions. Although the literature has many level five evidence reports, there is a lack of well-designed research to answer the same question and we intended to study it both in dominant and non-dominant limbs.

15 healthy adolescent volunteers were fitted with a custom adjustable brace that simulated forearm arthrodesis in five rotatory positions. They were asked to carry out a series of activities as per Sollerman's hand function test, and each activity was scored using the standardized scoring system. The test was carried out with the brace fitted first in the dominant side, followed by the non-dominant side, and finally in both the upper limbs together.

We found that the mid-prone position allowed for the best function overall in both dominant and non-dominant upper limbs, and if both upper limbs required simultaneous fusion, our results suggest that fixing the dominant side in mid-prone and non-dominant side in 45° supination would be ideal.

For unilateral forearm arthrodesis, the ideal position of fusion is the same irrespective of the dominance of the limb, whereas, for bilateral arthrodesis, limb dominance is to be taken into consideration.

Level III quasi-experimental study.