Thomas later included the volar radiocarpal fracture dislocation in his classification of smiths fractures as a smith type ii injury. A barton s fracture is an intraarticular fracture of the distal radius with dislocation of the radiocarpal joint. Classification and treatment of volar barton fractures. Therapeutic management for distal radius fractures.
Barton fractures extend through the dorsal aspect to the articular surface but not to the volar aspect. She underwent open reduction and fixation of the distal radius fracture, and current. It is a fracture of the distal radius which extends through the dorsal. This fracture entails either dorsal or volar fracture dislocation of the wrist. The peak incidence of all fractures of distal radius with open physes is at the adolescent growth spurt 1. A prospective study article pdf available in journal of orthopaedic surgery hong kong 122. Nietosvaara et al also reported distal radius physeal injuries occuring at an average of 12 years in males and 11 years in females 3. Improve participant understanding of and ability to read basic fractures.
It is also sometimes termed the dorsal type barton fracture to distinguish it from the volar type or reverse barton. It is named after john rhea barton an american surgeon who first described this in j bone joint surg am. From the department of orthopedics, dachien general hospital, miaoli. It is also sometimes termed the dorsal type barton fracture to distinguish it from the volar type or reverse barton fracture.
In the case of these marginal fractures, the shearing mechanism and obliquity of the fracture line result in volar and proximal subluxation of the carpus. They represent complex injuries, challenging to treat due to, in part, the anatomy of the volar surface of the distal part of the radius 14. Dorsal angulation of the distal fracture fragment is present to a variable degree as opposed to volar angulation of a smith fracture. Various surgical tech niques have been reported in the literature, but open reduction and internal fixation using a volar plate system is currently advocated for the treatment of volar barton s fractures. Turns out the pure volar barton s is not as common as one with an extra dorsal fracture jbjs. Conversely, surgery is recommended in the presence of the following. Dorsaltype barton s is a fracture dislocation of the dorsal rim of the radius. How to describe an xray to an orthopedic surgeon over the phone joshua a. Therapeutic effects of volar anatomical plates versus locking.
Reverse bartons fracture, open reduction and internal fixation orif, volar plating, distal radius, dash score. Bartons fracture is a fracture that occurs when there is an injury at the base of the thumb. In 1837, john rhea barton of philadelphia described both the dorsal and volar radiocarpal fracture dislocations. Volar barton s fractures are uncommon and extremely unstable.
Volar bartons fractures with concomitant dorsal fracture in older patients. Treatment of volar bartons fractures of the distal radius. From the department of orthopedics, dachien general. Guideline treatment of distal radius fractures in adults. The physis of the distal end of radius closes at the age of 1718 years 1. Results of treatment in 78 patients with volar barton s fractures have been analysed. On radiological assessment these fractures were divided into three distinct categories and this classification is related to the results of closed. Barton s fracture is the displaced intraarticular coronal plane fracture subluxation of dorsal lip of the distal radius with displacement of carpus with the fragment.
The barton s fracture is caused by a fall on an extended and pronated wrist increasing carpal compression force on the dorsal rim. Distal radius fractures, do they all need to be fixed. Intraarticular component distinguishes this fracture. Pdf open reduction and internal fixation of volar barton. John rhea barton described the barton fracture in 1838, with the definition refined later by hamilton in 1860. Volar radiocarpal fracturedislocation volar bartons. Data was collected prospectively on a consecutive series of twentyseven patients during routine postoperative visits at 2 and 6 weeks, and 3, 6, 12 and 24 months. On radiological assessment these fractures were divided into three distinct categories and this classification is related to the results of closed manipulation. Depressed fracture of the lunate fossa articular surface smiths. Failla, md, southfield, mi, clifford les, dvm, phd, detroit, mi closed reductionsugar tongsplint 50 patients, 3 lafontaine factors. To determine recovery timeline of unstable distal radius fractures treated by open reduction and internal fixation with a locking volar plate.
Rate of improvement following volar plate open reduction. Med ed lecom orthopedic and sports medicine peekn peak primary care conference winter 2016 goals and objectives goal 1. Features are consistent with a volar type barton fracture. Range of motion measures and grip strength for both wrists were.
Treatment of volar barton s fractures of the distal radius with tbuttress plates 633 p j m h s vol. Occasionally some degree of carpal displacement is also involved and this condition is termed as a fracture dislocation. Volar barton fracture is a shearing mechanism of injury that results in a fracture dislocation or subluxation of the distal end radius in which the volar rim of the distal end radius is displaced with the hand and carpus. Barton s fracture volar type barton s is a fracture dislocation of the fracturra rim of the radius. A retrospective clinical study of volar barton fractures using t ellis. The purpose of this study was to compare the therapeutic effects of volar. Distal radius fractures are very common fractures of the upper extremity. Evans, otrl, cht march 8, 2015 drf is the most common fx in human skeleton, comprising 18% of all fractures and affecting an estimated 85,000 medicare beneficiaries each year. A barton fracture can be described as volar more common or dorsal less common, depending on whether the volar or dorsal rim of the radius is involved. The comminuted fracture of the volar articular surface is associated with volar.
In all barton fractures the carpus was subluxed in the direction of the marginal fracture of the radius. Distal radius fractures orthopaedic trauma association ota. Barton, is a fracture of the distal end of the radius that involves the articu lar surface and is. A barton s fracture is an intraarticular fracture of the distal radius with dislocation of the radiocarpal joint there exist two types of barton s fracture dorsal and palmar, the latter being more common. There exist two types of barton s fracture dorsal 1 and palmar, the latter being more common. Open reduction and internal fixation of volar bartons. Prospective study of evaluation of outcomes of volar. Treatment of volar bartons fractures chang gung medical journal. Radiocarpal dislocation a complication after distal.
A malunion of a volar barton s fracture can cause serious disability, which is very complicated to treatment. Fracture dislocation of radiocarpal joint with intraarticular fracture involving the volar or dorsal lip chauffers. There is an interarticular oblique comminuted fracture of the distal radius, with volar displacement. Volar type barton s is a fracture dislocation of the volar rim of the radius. Evaluation of functional outcome of open reduction and internal. There is an axial ct image with 3d, coronal and sagittal reconstructiosn. A change of 10 degrees rotation between two consecutive control lateral radiographs is not uncommon fractuar clinical followup and results in 5 degrees change in apparent tilt.
Various surgical techniques have been reported in the literature, but open reduction and internal fixation using a volar. Treatment of distal radius fractures in adults norwegian orthopaedic association the norwegian medical association 5 of 111 volar locking plates yield a better early postoperative outcome than external fixation in. Open reduction and internal fixation of volar barton s fractures. Bartons fracture is a type of distal radius fracture that occurs near the base of the thumb. Distal radius fractures common injury fractures of the distal radius represent approximately 16% of all fractures treated by orthopaedic surgeons three main peaks of fracture distribution. Associated injuries may accompany distal radius fractures. Adolescent volar barton fracture with open physis treated. Bartons fracture health medical tests medical information. The volar barton fracture of the distal end of radius is. However, the volar barton fracture in the adolescent age group is rare and therefore poorly reported in the literature. The volar barton fracture of the distal end of radius is partially articular which requires anatomical reduction. Additionally, the articular cartilage may be severely injured and cannot regenerate.
Volar locking plates versus kwirepin fixation for the. Volar rim and volar or dorsal barton s fractures are considered among marginal articular shearing type fractures. This is an intraarticular fracture of the distal radius with associated dislocation of the radiocarpal joint. On the left a patient with a communitive intraarticular fracture of the distal radius with displacement of the volar rim of the radius together with the carpus i.
Distal radius fractures occur through the distal metaphysis of the radius may involve articular surface frequently involving the ulnar styloid most often result from a fall on the outstretched hand. Barton fractures are fractures of the distal radius. Evans, rb, 2015 1 therapeutic management for distal radius fractures. Reverse barton s occurs with wrist in palmarflexion and involves the volar lip. Open reduction and internal fixation of volar barton s fracture can restore articular congruity and result in good to excellent function. Therapeutic effects of volar anatomical plates versus. In the united states more than 500 000 cases per year are recorded, accounting for approximately one sixth of all fractures treated in orthopaedic departments. Volar plate fixation of some distal radius fractures such as the volar barton s fracture dislocation has been the standard for more than a decade.