Outcome following wrist fractures is difficult to assess. There are many methods used to assess outcome following distal radius fractures, but may be that simply asking the patient for their level of satisfaction may be enough. We looked at 50 wrist fractures at 12 weeks post injury and compared their level of satisfaction with various respected outcome measures (Gartland and Verley, Sarmiento, Cooney, Patient-Rated Wrist Evaluation, Hand Function Score, and Disability of Arm Shoulder and Hand Score) to determine whether there was a correlation with their level of satisfaction. The aim was to determine which wrist scoring system best correlates with patient satisfaction and functional outcome and which individual variables predict a good outcome. Forty-five females and 5 males with a mean age of 66 years (range 19 to 93 years) were included in the study. Multivariate regression analysis was carried out using SPSS 17.

Patient satisfaction correlated best with the MacDermid, Watts and DASH scores. The variables in these scoring systems that best accounted for hand function were pain, ability to perform household chores or usual occupation, open packets and cut meat.

The McDermid, Watts and DASH scores provide a better measure of patient satisfaction than the Gartland and Verley, Sarmiento and Cooney scores, however they are all time consuming, complicated and may indeed not be necessary.

The four most important questions to ask in the clinic following wrist fractures are about severity of pain, ability to open packets, cut meat and perform household chores or usual occupation. This may provide a simple and more concise means of assessing outcome after distal radial fractures.

Proximal femoral fracture (PFF) is already epidemic and projected to increase. 50% of patients fail to recover their preaccident mobility, resulting in protracted hospitalisation and exposure to nosocomial (hospital acquired) infections which impairs recovery further.

The aim of this study was to establish the rate at which patients with PFF regain mobility, the point at which they cease to recover and the incidence, time of onset and effect of nosocomial infections.

Recovery of mobility and nosocomial infection was prospectively recorded in 170 consecutive patients with PFF. 53% regained their best level of mobility within 6 days of admission, 81% within 8 and 91% within 14. The mean hospital stay was 21 days and delay to discharge was 14 days. During the delay, mobility deteriorated in 22% of patients and 58% developed nosocomial infection of which 18 were methicillin resistant staphylococcus aureus. The risk of infection doubled after a delay of 6 days.

Protracted hospitalisation after PFF is unhelpful and dangerous to patients and wasteful of healthcare resource. There is a small window of opportunity to discharge patients after PFF that is often missed. Thus there are often no beds for patients with acute fractures because they are occupied by patients who do not benefit from hospital admission or remain because they have acquired iatrogenic disease.