- Discussion:
- characterized by frx of volar margin of the carpal surface of the radius which is associated w/ subluxation of radiocarpal joint;
- similar to
Smith's type III;
- comminuted frx of distal radius may involve either anterior or posterior cortex and may extend into the wrist joint;
- both involve volar dislocation of carpus assoc w/ intra articular distal radius component;
- frx dislocation or subluxation in which the rim of distal radius, dorsally or volarly is displaced with the hand and carpus;
- it differs from
Colles' or
Smith's Fracture in that the dislocation is the most striking radiographic finding;
- volar Barton's is more common than
dorsal Barton frxs;
-
mechanism:
- usually result from a fall upon an outstretched arm, leading to dorsiflexion stress and tension failure of volar lip of radius;
- strong
volar radiocarpal ligaments avulse the volar lip of the radius from the metaphysis;
- Radiographs:
- frx cleft extends proximally in coronal plane in oblique direction, so that free fragment is wedge shaped;
- carpus is displaced volarly & proximally w/ articular fragment;
- w/ volar Barton's frx, it is critical to note whether there is more ulnar or radial sided comminution (since this will affect the choice of surgical approach);
- if necessary, order a CT scan to better define the anatomy;
- Non Operative Treatment:
- most of these fractures will require operative treatment;
- if non operative treatment is attempt, be sure to immobilize the wrist palmar flexed which will
tip the carpi away from the fractured volar surface;
- ORIF and Surgical Approach for Anteriorly Displaced Frx:
- ORIF is required for all displaced volar articular lip fractures;
- even with initial acceptable reduction (w/ wrist in extension), recurrance of palmar subluxation is common;
- strong proximal pull of the extrinsic wrist and digital flexors and extensors makes closed reduction difficult and predisposes joint to redisplacement;
-
implants:
- volar plates are well tolerated, and seldom need to be removed;
- small
T plate on the volar aspect;
- plate is bent in mid portion to effect
prebending effect;
- ensure that the distal margin of the plate does not encroach on the articular surface (using flouro);
- slight dorsal articular penetration may be allowable;
- begin w/ a proximal screw (
3.5 cortical) placed into the distal side of the oval hole, which will have
the effect of moving the plate distally (which then applies compression to the periarticular fragments);
- subsequently, insert the distal screw (
4.0 cancellous) only if it is needed;
Barton's Fractures.
JC de Oliveira. JBJS Vol 55-A, 1973. p 586-594.
Anterior and posterior marginal fracture-dislocations of the distal radius. An analysis of the results of treatment.
Barton's fractures - reverse Barton's fractures: Confusing eponyms.
GH Thompson and TT Grant. CORR. Vol 122, 1977. p 210-221.
Volar barton’s fractures with concomitant dorsal fracture in older patients.
