Do Variable Locking Plates Provide Better Functional and Radiological Outcomes in Volar Barton Fractures?

Abstract

A volar or reverse Barton fracture refers to an intra-articular distal radius fracture that extends out to the volar aspect of the distal radius and there may be subluxation or dislocation in that direction. The overall goal of managing volar Barton fractures is to obtain motion that is pain-free, allow the patient to return to their usual activities, and minimize the risk of development of early-onset arthritis which may cause disability. Though various management options are available, this study deals with the assessment of functional and radiological outcomes of volar Barton fracture fixed with a variable locking plate. A prospective, observational, and hospital-based study was conducted at R. L. Jalappa Hospital and Research Centre, Sri Devaraj Urs Medical College (SDUMC), Tamaka, India, on patients with volar Barton fracture managed with a variable locking plate from the period December 2019 to June 2021. Clinical data were assessed with Disabilities of Arm, Shoulder and Hand (DASH) score, Gartland and Werley demerit criteria, and Sarmiento modification of Lindstrom criteria. Results: Forty subjects with a mean age of 36.43 ± 10.59 years were included in the study. The mean flexion, extension, supination, and pronation were 70.63° ± 3.6°, 74.3° ± 3.64°, 79.83° ± 2.67°, and 76.28° ± 1.99° degrees respectively at the end of six months. Based on Gartland and Werley's outcome, the majority (65%) of the study population was found to have an excellent outcome, 30% had a good outcome and only 5% had a fair outcome. The mean DASH score was 13.98 ± 5.76. According to Sarmiento's modification of Lindstrom criteria, 22 patients had good radiological outcomes, 11 had excellent outcomes and seven hadfair outcomes. The study concludes that fixation of volar Barton fractures with variable locking plates has a better role in immediate stability, maintaining anatomic reduction, and early mobilization. It also provides better functional outcomes and a good anatomical reduction.