Assessing results after distal radius fracture treatment: a comparison of objective and subjective tools

Abstract

Objectives: Functional outcomes following distal radius fractures are directly influenced by the choice of outcome assessment instruments used. Our objective was to compare scoring systems in measuring patient functional outcomes and to determine which scoring system compared most favorably with the widely used Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Methods: In all, 108 patients between May 2004 and November 2006 were treated operatively following distal radius fractures. Follow-up was at 3 months, 6 months, 1 year, and 2 years postsurgery, during which anatomical and functional assessments were performed. Patient outcomes were recorded using DASH, Green and O’Brien system, Gartland and Werley system, and Sarmiento radiological scoring system. Results: There was a stronger correlation between the Green and O’Brien scoring system and DASH (r = −.54) than Gartland and Werley and DASH (r = .44). The Green and O’Brien scoring system was more demanding so patients rated “excellent” or “good” had better functional outcome than those bearing the same grade in the Gartland and Werley system. Nonetheless, the Green and O’Brien score and Gartland and Werley score showed good correlation with each other (r = .66). The Sarmiento radiological score had no significant correlation with any of the other scoring systems. Significant predictors of the DASH score were function (r = .42), power grip (r = .41), pain (r = .37), and range of motion (r = .28). Conclusion: The Green and O’Brien scoring system correlated most strongly with the DASH score. Radiological scoring (reflecting anatomical deformity) was not significantly correlated with functional outcome. While subjective parameters “pain” and “function” are influenced by psychosocial factors and thus highly variable, it is paramount to include subjective tools in outcome assessment in future studies on wrist fractures.