Buttress plating for volar Barton fractures in children: Salter-Harris II distal radius fractures in sagittal plane.

Abstract

We observed an unusual type of volar Barton fracture in the pediatric age and performed open reduction and internal fixation of the fragment, using the buttress plate in consecutive children. We report the radiological and clinical outcomes after follow-up for at least 3 years. From March 2008 to September 2014, nine consecutive children were treated by buttress plating. Their mean age at the time of injury was 13.1 years. All of the fractures were metaphyseal fractures in the coronal plane and typical Salter-Harris II fractures in the sagittal plane. After accurate reduction of the fragment, a cortical screw was inserted in the proximal area until the maximum compressive force against the fragment was obtained. Then, one or two locking screws were added adjacent to the initial cortical screw. No screw was fixed in the distal fragment. All evaluations were done at least 3 years postoperatively with a mean follow-up of 48.8 months. At final follow-up, the radial inclinations, volar tiltings, and ulnar variances were 23.2°±1.78° (98.7% of contralateral side), 9.4°±2.12° (98.4% of contralateral side), and -1.56±0.88 mm (93% of contralateral side), respectively. All radiological parameters of the distal radius were not significantly different from the contralateral values. The flexion-extension arc was 140.56°±5.27°, and the pronation-supination arc was 165.00°±8.29°. The grip strength was 26.67±5.56 kg. All clinical outcomes except the flexion-extension arc were similar to those of the normal side, with statistical significance. A volar Barton type injury can occur in the pediatric age involving the physis, and the buttress plating that is used in adults is also a useful treatment method. However, there is little information on this injury, and it was difficult to compare treatment outcomes with other methods. Because of the rarity of the injury, a larger, multicenter prospective comparative study is required to further explore appropriate treatment options, long-term outcomes, and complications. Level of Evidence: Therapeutic, Level IV.