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


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.



  1. 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.
  2. 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.
  3. 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.
  4. 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.