Neglected volar barton fracture treated by two-stage procedure

Abstract

Malunion following a neglected volar barton fracture can cause severe functional impairment owing to changes in normal anatomic and biomechanical relationships of the distal radius. These malunions, if mature can be treated by intra-articular osteotomies or the salvage procedures. But in nascent malunions, these procedures cannot be performed as the solid bony consolidation is absent and there is severe soft tissue contracture. In the present study, two-stage procedure was presented for the treatment of nascent neglected volar barton fracture presenting after 5 weeks, and treated primarily with gradual distraction and secondarily with open reduction and internal fixation with locked distal radius plate along with bone graft. Complete bony healing occurred in 6 months and Mayo wrist score improved from 31 to 85. At final follow-up after 2 years, visual and analog pain scores reduced from 68 to 11 and range of motion was 80 extension to 70 flexion along with near normal full grip strength along with mild wrist arthrosis. Surgical treatment of neglected fractures of distal radius can substantially improve wrist and hand functions, but rarely restores the limb to normal.