Garland and Werley developed a point system for evaluating the status of a healed Colles' fracture. Sarmiento made a slight modification to this system, calling it the demerit point system.
Elements:
(1) residual deformity
(2) subjective evaluation
(3) objective evaluation
(4) complications, arthritis
(5) complications, nerve
(6) complications, finger function
Criteria for objective evaluation indicating minimum for normal function:
(1) dorsiflexion: 45 degrees
(2) palmar flexion: 30 degrees
(3) radial deviation: 15 degrees
(4) ulnar deviation: 15 degrees
(5) pronation: 50 degrees
(6) supination: 50 degrees
|
Element |
Result |
Points |
|
residual deformity |
none |
0 |
|
|
prominent ulnar styloid |
1 |
|
|
residual dorsal tilt |
2 |
|
|
radial deviation of hand, mild to moderate |
2 |
|
|
radial deviation of hand, severe |
3 |
|
subjective evaluation |
no pain, disability, or limitation of motion (excellent) |
0 |
|
|
occasional pain, slight limitation of motion, no disability (good) |
2 |
|
|
occasional pain, some limitation of motion, feeling of weakness in wrist, no particular disability if careful, activities slightly restricted (fair) |
4 |
|
|
pain, limitations of motion, disability, activities more or less markedly restricted |
6 |
|
objective evaluation |
no loss or pain |
0 |
|
|
loss of dorsiflexion |
5 |
|
|
loss of ulnar deviation |
3 |
|
|
loss of supination |
2 |
|
|
loss of palmar flexion |
1 |
|
|
loss of radial deviation |
1 |
|
|
loss of circumduction |
1 |
|
|
pain in distal radio-ulnar joint |
1 |
|
arthritic complications |
none |
0 |
|
|
minimal |
1 |
|
|
minimal with pain |
3 |
|
|
moderate |
2 |
|
|
moderate with pain |
4 |
|
|
severe |
3 |
|
|
severe with pain |
5 |
|
nerve complications |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
poor finger function due to cast |
none |
0 |
|
|
minimal to mild |
1 |
|
|
moderate to severe |
2 |
where:
• The modification of Sarmiento et al was to add "loss of pronation" to the objective evaluation, scored at 2 points.
• Scoring objective findings can be done in 2 ways: (1) select 1 item, or (2) sum all losses present with maximum score allowed 5. I've opted for option #2 for the spreadsheet.
• The point range for objective evaluation ranges from 0 to 5.
score =
= SUM(points for all of the elements)
Interpretation:
• minimum score: 0
• maximum score: 24.
|
Score |
Outcome |
|
0 to 2 |
excellent |
|
3 to 8 |
good |
|
9 to 20 |
fair |
|
21 to 24 |
poor |
Specialty: Surgery, orthopedic
ICD-10: ,
