Abstract

Purpose To describe a variant of Barton’s volar articular shearing fracture of the distal radial articular surface with a subtle concomitant fracture of the dorsal metaphyseal cortex. Methods This fracture pattern was observed in 6 women and 2 men with an average age of 67 years (range, 58–76 years). All 8 patients were treated with a volar plate and screws. The dorsal metaphyseal fracture was not recognized in 5 patients and a volar buttress plating technique using an intentionally undercontoured volar plate was used. In 3 patients the dorsal fracture line was identified before surgery and the plate was contoured to fit the volar surface of the distal radius. Results All 5 patients treated with an undercontoured plate had loss of the normal palmar tilt of the distal radius (average,–9.4°; range, 0° to–22°) and dorsal translation of the distal radial articular fragments. For the entire group the palmar tilt averaged–5.9° (range, 0.0° to–22.0°), the ulnar inclination 19° (range, 10°–23°), and the ulnar variance–0.9 mm (range, 0.0 to–3.0 mm). All patients attained forearm supination of 80° and the average pronation was 75° (range, 45°–80°). According to Sarmiento’s modification of the system of Gartland and Werley there were 1 excellent, 6 good, and 1 fair results. The average Patient-Rated Wrist Evaluation score was 16 (range, 0–35). Conclusions Some fractures with an oblique volar marginal articular fracture of the distal radius and volar radiocarpal subluxation (known as Barton’s fracture) may also have a fracture through the dorsal metaphyseal cortex. Failure to identify this fracture line can lead to dorsal translation and angulation of the distal radius articular surface, particularly when an undercontoured volar plate is used for internal fixation.

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call

Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.