Gartland and Werley Score
Objective and Intended Population
The Gartland & Werley Score is a point-based outcome measure used to evaluate hand and wrist function . 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 
- the second included evaluation of stiffness and reflexes.
Method of Use
The score is based on a list of items categorised into four domains namely:
- residual deformity
- subjective evaluation
- objective evaluation
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:
|1.1||Prominent ulnar styloid||1|
|1.2||Residual dorsal tilt||2|
|1.3||Radial deviation of hand||2 to 3|
|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|
|3.1||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)|
|4.2||Minimal with pain||3|
|4.4||Moderate with pain||4|
|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:
21 or above: Poor
This outcome measure is reported to be broadly used by surgeons and in clinical reports . However, despite its broad application in the clinical setting, there is, to the date, no evidence concerning reliability, validity or responsiveness of the test.
- 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.