Gartland and Werley Score

Original Editor - Gabriele Dara

Top Contributors - Gabriele Dara and Shaimaa Eldib  

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. 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.