***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Outcome measurement following surgery is increasingly the focus of attention in current health-care debates because of the rising costs of medical care and the large variety of operative options . The purpose of the present study was to correlate quality of life after volar locked plate fixation of unstable intra-articular distal radial fractures with functional and radiographic results as well as with quality -of-life data from population norms . METHODS Fifty-four consecutive patients with intra-articular distal radial fractures and a mean age of sixty-three years were managed with a volar locked plate system .  Range of motion , grip strength , and radiographs were assessed at a mean of six years postoperatively . The wrist-scoring systems of Gartl and and Werley and Castaing were adopted for the assessment of objective outcomes . The Disabilities of the Arm , Shoulder and H and and Short Form-36 question naires were completed as subjective outcome measures , and the results were compared with United States and Austrian population norms . RESULTS Functional improvement continued for two years postoperatively . At the time of the latest follow-up , > 90 % of all patients had achieved good or excellent results according to the scoring systems of Gartl and and Werley and Castaing . The results of the Short Form-36 question naire were similar to the United States and Austrian population norms . The mean Disabilities of the Arm , Shoulder and H and score was 5 points at two years , and it increased to 13 points at six years . The twenty patients with radiocarpal arthritis had significantly poorer results in the physical component summary measure of the Short Form-36 question naire ( p = 0.012 ) . CONCLUSIONS The results of the present single-center study show that , following distal radial fracture fixation , wrist arthritis may affect the patient 's subjective well-being , as documented with the Short Form-36 , without influencing the functional outcome . Well- design ed longitudinal clinical trials are needed to confirm the findings of the present investigation in terms of quality of life after surgical treatment of intra-articular distal radial fractures We carried out a prospect i ve r and omised controlled clinical trial to compare the functional and radiological outcomes of casting with percutaneous pinning in treating extra-articular distal radial fracture in an elderly Chinese population . Sixty patients were r and omly allocated by sealed envelopes to either a ‘ Cast ’ group ( n = 30 ) or a ‘ K-wire ’ group ( n = 30 ) . All patients were available for final follow-up assessment . The radiological outcomes in terms of dorsal angulation , radial inclination and radial length were statistically significantly better in the K-wire group , whereas the Mayo wrist score and quality of life , healing rate , healing time , and complications were similar . The functional outcomes and quality of life were not affected by the treatments . Both treatments had a very low rate of complication and high healing rates Summary Health-related quality of life in elderly women with sustained incident fractures was assessed prospect ively for 1 year , using the EuroQol st and ard . Loss of QOL was more severe in patients after hip or vertebral fractures than those with wrist fracture .  QOL was not completely restored in patients suffering from hip fracture . Introduction Osteoporosis-related fractures decrease mobility , social interaction , and emotional well-being . All of these characteristics determine health-related quality of life ( HR-QOL ) . In this study , we assessed HR-QOL in elderly women following incident clinical fractures . Methods Thirty-seven patients with hip fractures ( mean age 76.1 years ) , 35 with vertebral fractures ( mean age 72.6 years ) , and 50 with wrist fractures ( mean age 68.6 years ) were enrolled .  HR-QOL was prospect ively measured using  EuroQol ( EQ-5D ) before the fracture , 2 weeks , 3 months , 6 months , and 1 year after the fracture . Results During the observation period , reduction of EQ-5D values was greatest in the hip fracture group . In the wrist fracture group , EQ-5D values at 6 months after the fracture showed recovery ; however , in the hip and vertebral fracture groups , recovery was significantly lower than before the fracture . One year after the fracture , EQ-5D values were not significantly different from prefracture values in the vertebral and wrist fracture groups , but remained significantly lower in the hip fracture group . Conclusions Loss of QOL was more severe in patients after hip or vertebral fractures than in patients with wrist fracture . HR-QOL was not completely restored in patients suffering from hip fracture We performed a prospect i ve cohort study on a consecutive series of 35 unstable , dorsally displaced distal radius fractures , which were treated with palmar locking plates and SmartLock locking screws . There were 17 men and 18 women with a mean age of 44 years who were review ed at a mean follow-up of 10 months . All the fractures healed at a mean time of 7 weeks . Radiographs did not show any change in alignment from the initial postoperative period until fracture union . The average Mayo wrist score was 90 after fracture union . One patient had an early loss of fracture reduction and one patient developed complex regional pain syndrome . There was no difference in the quality of life before and after surgery . Palmar plate fixation using SmartLock locking screws is effective and safe in stabilising unstable dorsally displaced distal radius fracture and produces good radiological and functional outcomes Background The incidence of distal radius fracture has increased substantially during the last 50 years according to several studies that estimated the overall incidence in various general population s. The incidence of fracture classified according to severity has not been well documented . The aim of this population -based study was to estimate the overall and type-specific incidence rates of distal radius fracture in a representative population in southern Sweden . Methods During 2001 , all persons older than 18 years with acute distal radius fracture in the southern Swedish region of Northeastern Scania were prospect ively recorded . A radiologist classified the fractures according to the AO system and measured volar tilt and ulnar variance . A fracture with volar tilt outside a range of -5 ° to 20 ° and /or ulnar variance of 2 mm or greater was defined as displaced . Results 335 persons with acute distal radius fracture were recorded during the 1-year period . The overall incidence rate was 26 ( 95 % confidence interval 23–29 ) per 10,000 person-years . Among women  the incidence rate increased rapidly from the age of 50 and reached a peak of 119 per 10,000 person-years in women 80 years and older . The incidence rate among women 50 to 79 years old ( 56 per 10,000 person-years ) was lower than that reported in previous studies of similar population s. Among men the incidence rate was low until the age of 80 years and older when it increased to 28 per 10,000 person-years . Fractures classified as AO type A comprised about 80 % of the fractures in women and 64 % in men . Almost two-thirds of all fractures were displaced and among men and women 80 years and older more than 80 % of the fractures were displaced . Conclusion The incidence rate of distal radius fracture in women 50 to 79 years old was lower than previously reported , which may indicate declining incidence in this group . In both sexes , the incidence was highest in the age group of 80 years and older . With a growing number of elderly in the general population , the impact of distal radius fracture in the future may be considerable Background Distal radius fracture is a common injury and may result in substantial dysfunction and pain . The purpose was to investigate the relationship between distal radius fracture malunion and  arm-related disability . Methods The prospect i ve population -based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast ( 55 patients ) or external and /or percutaneous pin fixation ( 88 patients ) . The patients were evaluated with the disabilities of the arm , shoulder and h and ( DASH ) question naire at baseline ( concerning disabilities before fracture ) and one year after fracture . The 1-year follow-up included the SF-12 health status question naire and clinical and radiographic examinations . Patients were classified into three hypothesized severity categories based on fracture malunion ; no malunion , malunion involving either dorsal tilt ( > 10 degrees ) or ulnar variance ( ≥1 mm ) , and combined malunion involving both dorsal tilt and ulnar variance . Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk ( RR ) of obtaining DASH score ≥15 and the number needed to harm ( NNH ) were calculated . Results The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category . The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion . The NNH was 2.5 ( 95 % CI 1.8 - 5.4 ) . Malunion had a statistically significant relationship with worse SF-12 score ( physical health ) and grip strength . Conclusion Malunion after distal radius fracture was associated with higher arm-related disability regardless of age Background and purpose Promising results have been reported after volar locked plating of unstable dorsally displaced distal radius fractures . We investigated whether volar locked plating results in better patient-perceived , objective functional and radiographic outcomes compared to the less invasive external fixation . Patients and methods 63 patients under 70 years of age , with an unstable extra-articular or non-comminuted intra-articular dorsally displaced distal radius fracture , were r and omized to volar locked plating ( n = 33 ) or bridging external fixation .  Patient-perceived outcome was assessed with the Disability of the Arm , Shoulder , and H and ( DASH ) question naire and the Patient-Rated Wrist Evaluation ( PRWE ) question naire . Results At 3 and 6 months , the volar plate group had better DASH and PRWE scores but at 12 months the scores were similar . Objective function , measured as grip strength and range of movement , was superior in the volar plate group but the differences diminished and were small at 12 months . Axial length and volar tilt were retained slightly better in the volar plate group . Interpretation Volar plate fixation is more advantageous than external fixation , in the early rehabilitation period The Medical Outcomes Study Short Form-36 ( SF-36 ) is a widely used measure of generic health related quality of life . The purpose of this study is to establish the validity and reliability of the SF-36 , Taiwan Version , when applied to a sample of elderly patients with hip fracture in Taiwan . Data from two sample s were used , the first sample ( n=87 ) from a prospect i ve descriptive study for testing psychometric scaling assumptions , scale responsiveness and criterion validity , and the second sample ( n=69 ) from a clinical trial for examining the validity of the differences in the group . The SF-36 Taiwan version demonstrated good evidence of supporting the scaling assumption . Cronbach ’s alpha coefficients above 0.70 for all scales support the internal consistency . The Physical Function ( PF ) scale had an effect size of 0.88 from months 1 to 3 , and 0.59 from months 3 to 6 after discharge , which appears to have the best responsiveness to clinical changes . Notable floor and ceiling effects ( > 15 % ) for Role Emotion ( RE ) , Role-Physical ( RP ) and PF scales were found . High correlation of 0.62 between the PF and measures of activities of daily living ( ADLs ) , and between RP and instrumental activities of daily living ( IADLs ) ( 0.63 ) supports the construct validity . Significantly higher performance in most SF-36 scales in elders without risk for depression than those who were at risk supported the validity of the group differences . In its current form , the SF-36 Taiwan version demonstrated good reliability and validity as applied to patients with hip fracture PURPOSE There have been few prospect i ve studies of elderly patients with conservatively treated distal radius fractures and little is known about the relationship between acceptable radiographic reduction and functional outcomes in this population . We hypothesized that acceptable fracture reduction ( according to st and ard radiographic dorsal/volar tilt criteria ) would be associated with better functional outcomes and greater satisfaction . METHODS Seventy-four patients who were at least 50 years of age with conservatively managed distal radius fractures were recruited from 2 large urban emergency departments from January 2001 to December 2001 . Patients with wrist fractures treated in the emergency department and discharged home were included ; patients admitted to the hospital or who required surgical reduction were excluded .  St and ard lateral radiographs were taken after the final cast was removed . These were review ed independently by a reference-st and ard musculoskeletal radiologist and the degree of dorsal/volar tilt was recorded . This value was dichotomized according to st and ard published dorsal/volar tilt criteria as acceptable ( dorsal tilt < 10 degrees or volar tilt < 20 degrees ) or unacceptable ( dorsal tilt > 10 degrees or volar tilt > 20 degrees ) . The Medical Outcomes Study Short-Form 12 ( SF-12 ) ; the Disabilities of the Arm , Shoulder , and H and question naire ; and a patient satisfaction survey were used to assess patient-reported outcomes 6 months after the injury . RESULTS The average dorsal/volar tilt measured by the reference st and ard radiologist was 3.4 degrees ( SD=13.6 ) d 
    Output:
    
In general , no differences were found in HS and (HR)QOL when comparing different treatment modalities .
Conclusions The focus of outcome research in DRF is mainly on HS instead of (HR)QOL .
HS instruments were often mislabeled as (HR)QOL instruments .