- 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
- 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;
- 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;
- 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
Anterior and posterior marginal fracture-dislocations of the distal radius. An analysis of the results of treatment.
Barton's fractures - reverse Barton's fracture. Confusing eponyms.
Volar barton’s fractures with concomitant dorsal fracture in older patients.
Original Text by Clifford R. Wheeless, III, MD.