human
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Background At present , there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius . This study compared the effectiveness of two methods used in surgical treatment of such fractures : percutaneous pinning and external fixation . Methods We r and omly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation .  Independent but not blinded evaluators administered the DASH quality -of-life question naire at postoperative months 6 and 24 , performed functional assessment of pain , range of motion , and palm grip strength , and radiographic examinations ( volar and radial angle , and height of the radius ) before the operation , immediately afterwards , and at 6 and 24 months postoperative . Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery . Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been r and omised according to the intention-to-treat principle . A significance level of 5 % ( alpha = 0.05 ) . was used for all statistical tests , such that tests presenting a p-value less than 0.05 were considered statistically significant . Results Ninety one ( 58.8 mean age and 66 participants were female ) were included in the final assessment at 24 months . The DASH question naire evaluation showed a statistically significant result favouring the De Palma group ( mean difference = -7.1 p = 0.044 ) after six months , but this was not maintained at 24 months . There were no statistically differences between the groups with respect to palm grip strength . Analysis of the range-of-motion limitation index ( uninjured side minus affected side motion of ) showed a statistical difference ( mean difference = 2.4 p = 0.043 ) favoring the external fixator group with regard to the supination movement 6 months after the operation ; however , this was not maintained at 24 months . The final results of the radiographic evaluation were similar for the two groups . Overall , five patients developed complications : two with De Palma pinning and three with external fixation . Conclusion There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH question naire , and for supination movement favouring the fixator group . However , both were not clinical relevant . By 24 months the groups were similar for all outcomes Trial registration Current Controlled Trials IS RCT The  Patient Evaluation Measure ( PEM ) , The  Michigan H and Outcome Question naire ( MHQ )  and the Disabilities of the Arm , Shoulder and H and ( DASH ) score were assessed independent of their originators for reliability , construct and criterion validity and acceptability , using an ease of use question naire . These were administered in r and om order to 100 patients with different h and and wrist disorders and with different impairments of movement , pain , sensation and strength . The internal consistency of all three question naires was very high suggesting redundancy in the questions . All question naires were reproducible and valid for finger and wrist disorders , but less for nerve disorders . All had poor construct validity . The PEM was the easiest to underst and and complete , taking the least time . Correlation between the scales is high and conversion equations were calculated . All three are reliable and reproducible patient completed question naires , but the PEM is the easiest to use . The validity of all is suspected for nerve disorders We performed a prospect i ve , r and omised trial to evaluate the outcome after surgery of displaced , unstable fractures of the distal radius . A total of 280 consecutive patients were enrolled in a prospect i ve data base and 88 identified who met the inclusion criteria for surgery . They were r and omised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws . Both groups were similar in terms of age , gender , h and dominance , fracture pattern , socio-economic status and medical co-morbidities . Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist , this advantage diminished with time and in absolute terms the difference in range of movement was clinical ly unimportant . Radiologically , there were no clinical ly significant differences in the reductions , although more patients with AO/OTA ( Orthopaedic Trauma Association ) type C fractures were allocated to the external fixation group . The function at one year was similar in the two groups . No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted 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 Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position , the treatment of choice is operation . The type of operation and the choice of implant , however , is a matter of discussion . Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation . Methods 50 patients with an unstable or comminute distal radius fracture were r and omized to either closed reduction and bridging external fixation , or open reduction and internal fixation using the TriMed system . The primary outcome parameter was grip strength , but the patients were followed for 1 year with objective clinical assessment , subjective outcome using DASH , and radiographic examination . Results At 1 year postoperatively , grip strength was 90 % ( SD 16 ) of the uninjured side in the internal fixation group and 78 % ( 17 ) in the external fixation group . Pronation/supination was 150 ° ( 15 ) in the internal fixation group and 136 ° ( 20 ) in the external fixation group at 1 year . There were no differences in DASH scores or in radiographic parameters . 5 patients in the external fixation group were reoperated due to malunion , as compared to 1 in the internal fixation group . 7 other cases were classified as radiographic malunion : 5 in the external fixation group and 2 in the internal fixation group . Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year , and tended to have less malunions  than external fixation . No difference could be found regarding subjective outcome In a r and omised prospect i ve study , 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning . Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning . The patients were evaluated clinical ly and radiologically at follow-up of 24 months . The Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire and modified Mayo wrist score were used at 3 , 9 , 12 and 24 months postoperatively . In the arthroscopically- and fluoroscopically-assisted group , triangular fibrocartilage complex tears were found in 12 patients ( 60 % ) , complete or incomplete scapholunate ligament tears in nine ( 45 % ) , and lunotriquetral ligament tears in four ( 20 % ) . They were treated either arthroscopically or by open operation . Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination , extension and flexion at all time points than those who had fluoroscopically-assisted surgery . The mean DASH scores were similar for both groups at 24 months , whereas the difference in the mean modified Mayo wrist scores remained statistically significant . Although the groups are small , it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome . Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome Background The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint . The relation between fractures of the ulna and distal radius is not clear , especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures . The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures . Methods A total of 100 patients with unstable and reducible distal radius fractures , with or without an ulnar styloid fracture , were r and omly assigned to treatment with transarticular bridging external fixation or transulnar percutaneous pinning . Follow-up was obtained for 91 patients . For the secondary data analysis , three patient cohorts were created : a no ulnar styloid fracture group with the radius fracture treated by pinning or external fixation ( n = 30 ) ; an ulnar styloid fracture with radius fracture group treated by external fixation ( n = 31 ) ; and an ulnar styloid fracture with radius fracture treated by pinning ( n = 30 ) . Functional and radiological outcomes were measured at 6 and 24 months . Functional outcome measures included wrist pain ( visual analogue scale ) and the Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire . Results At 24 months , patients with both fractures had worse wrist pain and worse scores on the DASH question naire than the patients with an isolated distal radius fracture ; and those treated by pinning had less wrist pain and showed better scores on the DASH question naire than 
    Output:
    
agent
Only the DASH and PRWE have evidence of reliability , validity , and responsiveness in patients with traumatic injuries to the h and and wrist ; other measures either have incomplete evidence or evidence gathered in a nontraumatic population .
Conclusions : The DASH and PRWE both have evidence of reliability , validity , and responsiveness in a h and and wrist trauma population .
Other PROMs used to assess h and and wrist trauma patients do not .
***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    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 Background At present , there is no conclusive evidence regarding the best treatment method for reducible unstable fractures of the distal radius . This study compared the effectiveness of two methods used in surgical treatment of such fractures : percutaneous pinning and external fixation . Methods We r and omly allocated 100 patients into two groups treated surgically with modified De Palma percutaneous pinning and bridging external fixation .  Independent but not blinded evaluators administered the DASH quality -of-life question naire at postoperative months 6 and 24 , performed functional assessment of pain , range of motion , and palm grip strength , and radiographic examinations ( volar and radial angle , and height of the radius ) before the operation , immediately afterwards , and at 6 and 24 months postoperative . Modified De Palma percutaneous pinning patients used an above-elbow cast whereas external fixation group had unrestricted elbow motion after surgery . Patients who for any reason demonstrated treatment failure or required additional interventions were followed up and their results were included in the group into which these patients had initially been r and omised according to the intention-to-treat principle . A significance level of 5 % ( alpha = 0.05 ) . was used for all statistical tests , such that tests presenting a p-value less than 0.05 were considered statistically significant . Results Ninety one ( 58.8 mean age and 66 participants were female ) were included in the final assessment at 24 months . The DASH question naire evaluation showed a statistically significant result favouring the De Palma group ( mean difference = -7.1 p = 0.044 ) after six months , but this was not maintained at 24 months . There were no statistically differences between the groups with respect to palm grip strength . Analysis of the range-of-motion limitation index ( uninjured side minus affected side motion of ) showed a statistical difference ( mean difference = 2.4 p = 0.043 ) favoring the external fixator group with regard to the supination movement 6 months after the operation ; however , this was not maintained at 24 months . The final results of the radiographic evaluation were similar for the two groups . Overall , five patients developed complications : two with De Palma pinning and three with external fixation . Conclusion There was a small statistically significant difference favouring the De Palma method in early functional at 6 months according to the DASH question naire , and for supination movement favouring the fixator group . However , both were not clinical relevant . By 24 months the groups were similar for all outcomes Trial registration Current Controlled Trials IS RCT The  Patient Evaluation Measure ( PEM ) , The  Michigan H and Outcome Question naire ( MHQ )  and the Disabilities of the Arm , Shoulder and H and ( DASH ) score were assessed independent of their originators for reliability , construct and criterion validity and acceptability , using an ease of use question naire . These were administered in r and om order to 100 patients with different h and and wrist disorders and with different impairments of movement , pain , sensation and strength . The internal consistency of all three question naires was very high suggesting redundancy in the questions . All question naires were reproducible and valid for finger and wrist disorders , but less for nerve disorders . All had poor construct validity . The PEM was the easiest to underst and and complete , taking the least time . Correlation between the scales is high and conversion equations were calculated . All three are reliable and reproducible patient completed question naires , but the PEM is the easiest to use . The validity of all is suspected for nerve disorders We performed a prospect i ve , r and omised trial to evaluate the outcome after surgery of displaced , unstable fractures of the distal radius . A total of 280 consecutive patients were enrolled in a prospect i ve data base and 88 identified who met the inclusion criteria for surgery . They were r and omised to receive either bridging external fixation with supplementary Kirschner-wire fixation or volar-locked plating with screws . Both groups were similar in terms of age , gender , h and dominance , fracture pattern , socio-economic status and medical co-morbidities . Although the patients treated by volar plating had a statistically significant early improvement in the range of movement of the wrist , this advantage diminished with time and in absolute terms the difference in range of movement was clinical ly unimportant . Radiologically , there were no clinical ly significant differences in the reductions , although more patients with AO/OTA ( Orthopaedic Trauma Association ) type C fractures were allocated to the external fixation group . The function at one year was similar in the two groups . No clear advantage could be demonstrated with either treatment but fewer re-operations were required in the external fixation group Background . This paper aim ed to identify condition-specific patient-reported outcome measures used in clinical trials among people with wrist osteoarthritis and summarise empirical peer- review ed evidence supporting their reliability , validity , and responsiveness to change . Methods . A systematic review of r and omised controlled trials among people with wrist osteoarthritis was undertaken . Studies reporting reliability , validity , or responsiveness were identified using a systematic reverse citation trail audit procedure . Psychometric properties of the instruments were examined against predefined criteria and summarised . Results . Thirteen clinical trials met inclusion criteria . The most common patient-reported outcome was the disabilities of the arm , shoulder , and h and question naire ( DASH ) . The DASH , the  Michigan H and Outcomes Question naire ( MHQ ) , the  Patient Evaluation Measure ( PEM ) , and the  Patient-Reported Wrist Evaluation ( PRWE ) had evidence supporting their reliability , validity , and responsiveness . A post-hoc review of excluded studies revealed the AUSCAN Osteoarthritis H and Index as another suitable instrument that had favourable reliability , validity , and responsiveness . Conclusions . The DASH , MHQ , and AUSCAN Osteoarthritis H and Index instruments were supported by the most favourable empirical evidence for validity , reliability , and responsiveness . The PEM and PRWE also had favourable empirical evidence reported for these elements . Further psychometric testing of these instruments among people with wrist osteoarthritis is warranted 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 Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position , the treatment of choice is operation . The type of operation and the choice of implant , however , is a matter of discussion . Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation . Methods 50 patients with an unstable or comminute distal radius fracture were r and omized to either closed reduction and bridging external fixation , or open reduction and internal fixation using the TriMed system . The primary outcome parameter was grip strength , but the patients were followed for 1 year with objective clinical assessment , subjective outcome using DASH , and radiographic examination . Results At 1 year postoperatively , grip strength was 90 % ( SD 16 ) of the uninjured side in the internal fixation group and 78 % ( 17 ) in the external fixation group . Pronation/supination was 150 ° ( 15 ) in the internal fixation group and 136 ° ( 20 ) in the external fixation group at 1 year . There were no differences in DASH scores or in radiographic parameters . 5 patients in the external fixation group were reoperated due to malunion , as compared to 1 in the internal fixation group . 7 other cases were classified as radiographic malunion : 5 in the external fixation group and 2 in the internal fixation group . Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year , and tended to have less malunions  than external fixation . No difference could be found regarding subjective outcome In a r and omised prospect i ve study , 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning . Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning . The patients were evaluated clinical ly and radiologically at follow-up of 24 months . The Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire and modified Mayo wrist score were used at 3 , 9 , 12 and 24 months postoperatively . In the arthroscopically- and fluoroscopically-assisted group , triangular fibrocartilage complex tears were found in 12 patients ( 60 % ) , complete or incomplete scapholunate ligament tears in nine ( 45 % ) , and lunotriquetral ligament tears in four ( 20 % ) . They were treated either arthroscopically or by open operation . Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination , extension and flexion at all time points than those who had fluoroscopically-assisted surgery . The mean DASH scores were similar for both groups at 24 months , whereas the difference in the mean modified Mayo wrist scores remained statistically significant . Although the groups are small , it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome . Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome Background The ulnar styloid is a supportive structure for the capsular ligament complex of the distal radioulnar joint . The relation between fractures of the ulna and distal radius is not clear , especially in regard to whether ulnar fractures predict worse outcomes for distal radius fractures . The objective of this study was to analyze the influence of ulnar styloid fractures in patients with reducible and unstable distal radius fractures . Methods A total of 100 patients with unstable and reducible distal radius fractures , with or without an ulnar styloid fracture , were r and omly assigned to treatment with transarticular bridging external fixation or transulnar percutaneous pinning . Follow-up was obtained for 91 patients . For the secondary data analysis , three patient cohorts were created : a no ulnar styloid fracture group with the radius fracture treated by pinning or external fixation ( n = 30 ) ; an ulnar styloid fracture with radius fracture group treated by external fixation ( n = 31 ) ; and an ulnar styloid fracture with radius fracture treated by pinning ( n = 30 ) . Functional and radiological outcomes were measured at 6 and 24 months . Functional outcome measures included wrist pain ( visual analogue scale ) and the Disabilities of the Arm , Shoulder , and H and ( DASH ) question naire . Results At 24 months , patients with both fractures had worse wrist pain and worse scores on the DASH question naire than the patients with an isolated distal radius fracture ; and those treated by pinning had less wrist pain and showed better scores on the DASH question naire than 
    Output:
    