Gartland and Werley Score
Original Editor - Gabriele Dara
Top Contributors - Gabriele Dara, Shaimaa Eldib and Kim Jackson
Objective and Intended Population
The Gartland & Werley Score is a point-based outcome measure used to evaluate hand and wrist function [1]. The scale, developed in 1951, was initially created for the evaluation of healed Colles fractures. The original scale is based on a "demerit" scoring system involving subjective and objective aspects related to wrist and hand function, residual deformities, range of motion and nerve complications.
Two modified versions of the scale have been implemented:
- The first included measures of pronation and strength [2]
- the second included evaluation of stiffness and reflexes[3].
Method of Use
The score is based on a list of items categorised into four domains namely:
- residual deformity
- subjective evaluation
- objective evaluation
- complications
Each assessed item is evaluated based on a demerit point system. The total score of the four domains is then summed up to construct the final score of the whole test. A final total score of 21 or above refers to "poor" hand function following an "healed" Colles fracture.
The list of items with relative scores and cut-offs is presented below:
| Section | Results | Points |
|---|---|---|
| 1 | Residual deformities | |
| 1.1 | Prominent ulnar styloid | 1 |
| 1.2 | Residual dorsal tilt | 2 |
| 1.3 | Radial deviation of hand | 2 to 3 |
| 2 | Subjective evaluation | |
| 2.1 | No pain, disability or limitation in motion (Excellent) | 0 |
| 2.2 | Occasional pain, slight limitation in motion, no disability (Good) | 2 |
| 2.3 | Occasional pain, some limitation of motion, feeling of weakness in the wrist, no particular disability if careful, activities slightly restricted (Fair). | 4 |
| 2.4 | Pain, limitation of motion, disability, activities more or less markedly restricted (Poor) | 6 |
| 3 | Objective evaluation | |
| 3.1 | Loss of dorsiflexion | 5 |
| 3.2 | Loss of ulnar deviation | 3 |
| 3.3 | Loss of supination | 2 |
| 3.4 | Loss of palmar flexion | 1 |
| 3.5 | Loss of radial deviation | 1 |
| 3.6 | Loss of circumduction | 1 |
| 3.7 | Pain in distal radio-ulnar joint | 1 |
| 4 | Complications (Arthritic change) | |
| 4.1 | Minimal | 1 |
| 4.2 | Minimal with pain | 3 |
| 4.3 | Moderate | 2 |
| 4.4 | Moderate with pain | 4 |
| 4.5 | Severe | 3 |
| 4.6 | Severe with pain | 5 |
| 4.7 | Nerve complications (Median) | 1 to 3 |
| 4.8 | Poor finger function due to cast | 1 to 2 |
Cut-off scores for end-results point ranges are presented as following:
0-2: Excellent
3-8: Good
9-20: Fair
21 or above: Poor
Evidence
This outcome measure is reported to be broadly used by surgeons and in clinical reports [1][4]. However, despite its broad application in the clinical setting, there is, to the date, no evidence concerning reliability, validity or responsiveness of the test.
Links
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1007.7785&rep=rep1&type=pdf
References
- ↑ 1.0 1.1 Changulani M, Okonkwo U, Keswani T, Kalairajah Y. Outcome evaluation measures for wrist and hand–which one to choose?. International orthopaedics. 2008 Feb 1;32(1):1-6.
- ↑ Sarmiento A, Pratt GW, Berry NC, Sinclair WF. Colles' fractures. Functional bracing in supination. The Journal of bone and joint surgery. American volume. 1975 Apr;57(3):311-7.
- ↑ Lucas GL, Sachtjen KM. An analysis of hand function in patients with Colles' fracture treated by Rush rod fixation. Clinical Orthopaedics and Related Research®. 1981 Mar 1;155:172-9.
- ↑ Dacombe PJ, Amirfeyz R, Davis T. Patient-reported outcome measures for hand and wrist trauma: is there sufficient evidence of reliability, validity, and responsiveness?. Hand. 2016 Mar;11(1):11-21.