Barton Fracture Research Articles

Functional Outcome of Volar Barton Fracture of Distal End Radius Undergoing Plating

Background: Volar Barton fractures of the distal radius are complex intra-articular injuries that often require surgical intervention for optimal functional recovery. Volar plating is commonly used to achieve stable fixation and early mobilization.Objective: This study aimed to evaluate the functional outcomes and complications in patients with volar Barton fractures of the distal radius treated with volar plating.Methods: This prospective study was conducted from March 2023 to March 2024, including 60 patients aged 18-60 years with AO/ASIF type B3 volar Barton fractures. All patients underwent open reduction internal fixation (ORIF) using a volar locking plate through a modified Henry approach. Postoperative assessments were performed at six months using Gartland and Werley’s wrist score. Data analysis was conducted using SPSS 25, with one-way ANOVA applied to evaluate associations between variables, considering a p-value < 0.05 as significant.Results: The average age was 34.43 ± 12.34 years. Excellent functional outcomes were achieved in 61.7% of patients, good in 30%, fair in 6.7%, and poor in 1.7%. Complications were minimal, with 95% of patients reporting none, 3.3% experiencing wound infections, and 1.7% reporting wrist stiffness.Conclusion: Volar plating for volar Barton fractures showed excellent to good functional outcomes in most patients, with minimal complications. Further studies with larger populations are recommended.

Comparison of treatment of volar Barton's fracture with T plate using distal end screws and without distal end screws.

To compare the functional and radiological outcomes of treatment of volar Barton's fractures using T plate with and without distal end screws. This randomized control trial was conducted at the department of Orthopedics, Mayo Hospital, Lahore, Pakistan from December 2021 to May 2022. Total 60 patients (30 in each group) were randomly allocated to either group A (T-Plate with distal end screws) or B (T-Plate without distal end screws). Patients were followed up on day-0, day-14, day-28 and day-90. Assessments of patients were done by Green O'Brien Score for pain, Modified Warden Score for callus formation on radiographs at 12-weeks of follow-up and Stewart Score for displacement of fracture. At 90th day, significant difference was seen in Green O'Brien Score (Excellent score: Group-A: 80% vs. Group-B: 90%, p=0.278) while Stewart scores remained comparable (Excellent Score: Group-A: 93.33% vs. Group-B: 96.67%, p=0.221) between treatment groups. Fracture healing assessed with Modified Warden score for score 4 did not show significant difference between both groups at 90th day. i.e. (Group-A: 96.67% vs. Group-B: 96.67%). However, callus formation assessed with Modified Warden score for score 3 showed significant differences between groups at 90th day. i.e. (Group-A: 53.33% vs. Group-B: 86.67%, p=0.001). Both treatment approaches appear to yield comparable outcomes in terms of clinical assessment, Stewart scores, and fracture healing, with a potential advantage for T-plate without distal end screw in callus formation at the 90th day.Trial registration: IRCT20221231056999N1.

PANORAMIC REVIEW OF DISTAL RADIUS FRACTURES

Introduction: fractures affecting the distal radius are common, their incidence increases as life expectancy increases, leading to a larger population of individuals at risk of suffering these injuries. They are usually comminuted and intra-articular fractures that are outside the traditional eponymous classification. Objective: to detail current information related to distal radius fractures epidemiology, anatomy, mechanism of injury, clinical evaluation, classification, imaging evaluation, treatment and complications. Methodology: a total of 27 articles were analyzed in this review, including review and original articles, as well as clinical cases and books, of which 19 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: distal radius fractures, radius anatomy, Colles fracture, Smith fracture, Barton fracture, treatment of distal radius fractures. Results: distal radius fractures account for about one sixth of all fractures treated in the emergency department, the incidence of distal radius fractures in the elderly correlates with the degree of osteopenia and increases with increasing age. The volar ligaments are stronger and provide greater stability to the radiocarpal joint compared to the dorsal ligaments. The most common mechanism is a fall on the hand in extension with the wrist in dorsiflexion. Currently, there is no consensus on the most optimal classification system for distal radius fractures. Conclusions: knowing correctly the whole picture of distal radius fractures allows to have a better performance when treating them. It is essential not to overlook in the physical examination the exploration of the ipsilateral elbow and shoulder to rule out the presence of associated injuries and to perform a complete evaluation to detect other possible injuries or life-threatening problems. Distal radius fractures can be treated conservatively or surgically depending on several factors, so classification is essential. There are multiple alternatives in surgical treatment, so the most appropriate one should be chosen for each case. The most common complications in this type of fracture are median nerve dysfunction, post-traumatic osteoarthritis, malunion or pseudoarthrosis and stiffness of the fingers, wrist and elbow. KEY WORDS: fracture, distal radius, Colles, Smith, Barton, treatment.

Early Results of Surgical Treatment of Volar Barton Fractures by Plating In Adults

Early Results of Surgical Treatment of Volar Barton Fractures by Plating In Adults

Certain fracture patterns in children/adolescents would be better called 'Barton equivalent' fractures.

We have encountered consecutive children/adolescents with a volar Barton fracture (VBF) pattern without involving the physis. These were managed by buttress plating; thus, we would like to report the radiological and clinical outcomes through retrospective case series and suggest the revisiting of the 'VBF category' in this population. We screened children/adolescents with a diagnosis of trauma to the bony structures in the wrist from 2008 to 2019. Of these patients, 16 who met our inclusion/exclusion criteria were investigated. At the final follow-up performed at least 2 years postoperatively, radiologic and clinical outcomes were evaluated. The mean age at the time of injury was 12.88 years old. At the final follow-up, the volar tiltings, radial inclinations and ulnar variances were 10.13°, 20.88° and -0.50 mm, respectively. None of these radiologic parameters were significantly different from the contralateral values, except the radial inclination. The mean visual analog scale score was 0.38. The mean range of motion arcs were 136.56° and 157.81° in the flexion-extension and pronation-supination arcs, respectively, and the grip strength was 22.00 kg. The mean modified Mayo Wrist Score was 92.8. The radiologic and clinical outcomes compared with the contralateral side were not significantly different from those in a previous report. A VBF pattern without involving the physis in the child/adolescent population was treated satisfactorily by buttress plating. Thus, including the previously reported 'SH-II in sagittal plane' injuries, the current injury pattern would be better called a 'Barton equivalent' fracture. Level of Evidence: Level IV, retrospective case series.

Osteosynthesis with Variable Angle Volar Plate in Dorsal Barton Fracture Due to Blunt Trauma: Clinical Case

Distal radius fractures in young adults are associated with high-energy trauma and in elderly people with low-energy falls. One of the distal radius fractures is the Barton Fracture (BF), a radiocarpal fracture-luxation whose production mechanism usually varies, the most common being a fall on an extended and pronated wrist. We present a 27-year-old male patient with distal radius epiphysis injury with radiocarpal dislocation following blunt trauma. Timely osteosynthesis with variable angle volar plate favored the restoration of distal radiocarpal and radioulnar biomechanics.

Osteosynthesis with Variable Angle Volar Plate in Dorsal Barton Fracture Due to Blunt Trauma: Clinical Case

Osteosynthesis with Variable Angle Volar Plate in Dorsal Barton Fracture Due to Blunt Trauma: Clinical Case

FUNCTIONAL EVALUATION OF VOLAR BARTON FRACTURES MANAGED WITH ANATOMICAL PLATING AT A TERTIARY CARE CENTER IN NEPAL: A RETROSPECTIVE REVIEW OF RECORDS.

Introduction Distal end radius fractures have been extensively studied in literature and yet many aspects of management remain controversial. Volar Barton fractures have been treated surgically with volar locking plates. Very few dedicated studies have been conducted in Nepal. The aim of this study was to describe the functional outcomes of Volar Barton fractures managed with open reduction and internal xation (ORIF) and Volar plating at a high volume tertiary care centre in Nepal. This retrospective Methodology review of patients was conducted after approval of the institutional ethics committee. A review of records of patients operate in the last 24 months was be performed. Patients aged 18 to 65 years who had been operated for Volar Barton fractures (AO type B3) within 3 weeks of injury with ORIF and Volar plating with a minimum of 12 months follow up were included in the study. Data regarding demographics, side of injury, functional outcomes using the Patient rated wrist evaluation (PRWE), Modied Mayo Wrist score and Radiological parameters. Statistical analysis of the data was done. Proportion, percentage, mean, standard deviation was calculated. A total of 180 records of patients who underwent ORIF Results and plating between 1st April 2021 to 31st March 2021 were identied. Of these 50 patients met the inclusion criteria and were included in the analysis. The mean age of the patients was 36.4 ± 1.4 years (18- 62 years). All fractures united with a mean union time of 5.7 ± 3.2 weeks. On radiographic assessment at 12 months the Volar tilt was 5.23 ± 2.41®, mean radial height was 9.23 ± 2.2®. Radial inclination was 22.9 ± 5.0®. The mean articular step was 0.3 ± 0.5 mm. Functional outcomes using the PRWE at 12 months was 3.5 ± 1.3. The Modied Mayo score was 82.12 ± 7.3. Conclusion Volar plating provides good functional and radiological outcomes in our study population. It has good union rates and a relatively low complication rate.

Outcome Analysis of Adult Distal Radius Fractures Managed during COVID-19 Pandemic.

COVID-19 pandemic created extreme pressure situation on health care services across the globe with shortage of medical staff and beds. The management of fragility fracture also affected significantly. The distal radius fractures (DRFs) are one of the common frailty fractures. There was a significant shift in the treatment of such injuries with new guidelines leaning toward more of non-operative management. A retrospective cross-sectional study of DRFs (DRF) treated during COVID pandemic for a period of 1 year in the United Kingdom. This included all radiologically confirmed cases of DRFs with isolated adult injuries excluding polytrauma, same limb other injuries, associated neurovascular injuries, and age below 18 years. All patient's data were collected from hospital records retrospectively from April 2020 to March 2021. There were a total of 179 patients with distal radius fracture, of which 141 (78.8%) were females and 38 (21.2%) males. The mean age was 68.2 years (SD 68.20 ± 15.63) and there were greater number of patients with intra-articular fracture. There were 28.5% (Grades 1 and 2, Group I) extra-articular fractures; 69.8% (Grades 3-8, Group II) were intra-articular fractures and 3 Barton's fractures (Group III) accounted to 1.7%. 137 patients were (76.5%) treated to non-operatively and 42 (23.5%) were treated surgically. 135 (75.4%) patients had good and 43 (24%) satisfactory clinical outcomes. 3 (1.6%) patients required osteotomy for malunited fractures. Fracture grade I and II is significantly associated with non-operative procedure (100.0% vs 84.3%) with P < 0.001. This study confirmed that non-operative treatment is still a good option even in intra-articular fractures. Surgical fixation should be considered in young patients and those with higher grade of fracture classification and greater angulation at presentation. A virtual physiotherapy is still a good option.

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

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.

Outcome of Volar Barton Fractures Treated with Locking Compression Plates: A Cross-Sectional Study

Volar Barton fracture is the fracture of distal radius bone associated with ventral displacement. It is an oblique intra-articular fracture. Objective: To investigate the results, both functional and radiological, of open reduction and internal fixation with locking compression plates of the volar Barton fracture. Methods: A total of fifteen patients were included in this study. All of the participants had volar fragment type B3 fractures of the wrist. All the patients underwent open reduction to treat the fracture. Internal fixation was done using a locking compression plate (LCP). Out of a total of 15 patients, 10 were male and 5 females. The most common cause, almost 67 %, of the fracture was a road traffic accident (RTA). The mean age of the patients was 33 years, ranging from 21 to 55 years. All the patients had their respective surgeries within 7 days of the fracture accident. Quick Dash score-, and Gartland and Werley score were used to assess the function of the hand and wrist. Results: All the fractures took the meantime of 8 weeks for the bone union. The mean Quick Dash score was 10, ranging from 0 to 60. According to Gartland and Werley’s score, 9 patients were excellent, 4 patients were good and 2 were fair. No postoperative complication occurred. Conclusions: Open reduction and internal fixation with locking compression plates of the volar Barton fracture is an effective treatment for functional and radiological restoration.

Evaluation of Treatment of Unstable Distal Radial Fractures by External Fixator

Background: Distal radial fractures are very common in Orthopaedic practice but still there is no unanimity about its treatment. Objective: To evaluate the external fixator for the treatment of unstable distal radius fractures. Methods: This prospective observational study was carried out from January 2018 to December 2019 over a period of two years. Twenty-five consecutive patients of both sexes between the ages of 18 to 60 years with closed or open unstable distal radius fractures with or without intraarticular extension admitted in the Department of Orthopaedic Surgery, 250 Bedded General Hospital, Tangail &amp; several private hospitals in Tangail &amp; Dhaka city were selected. Patients with diabetes mellitus or chronic renal or hepatic disorder or extra-articular fractures or volar &amp; dorsal shear injuries (Barton fractures) were excluded from this study. All the patients were evaluated thoroughly including distal neurovascular status and any associated injuries ruled out. Patients were operated as early as possible. But 4 cases were lost to follow up. Remaining 21 patients were followed up for at least 6 months and a maximum period of 12 months. Results: In this series mean age of the patient was 35.71±11.65 years and males (66.7%) were predominant than females (33.3%). In this series right side was involved in 13 patients (61.9%) and left side in 8 patients (38.1%). The mechanism of injury included road traffic accident 13 (61.9%), fall on slippery ground 7 (33.3%) and occupational accident 1 (4.8%). Six patients of this study (28.6%) had associated injury other than the local soft tissue injury. Most of the patients (66.7%) were operated on the day of admission, 2 patients (9.5%) were operated within 3 days and 5 patients (23.8%) were operated within 7 days. As per AO classification, majority (38.1%) injury was type C3 fracture followed by C1 (33.3%), C2 (14.3%), B1 (9.5%) and A3 (4.8%). According to functional outcome, satisfactory was 76.2% and according to anatomical outcome, satisfactory was 85.7%. Conclusion: According to this study finding satisfactory outcome was 76.2% (functional) and 85.7% (anatomical). J Shaheed Suhrawardy Med Coll 2021; 13(1): 20-25

POLYAXIAL ANATOMICAL VOLAR LOCKING PLATE – ONE SOLUTION FOR ALL

INTRODUCTION: Distal radius intra-articular fractures are frequent and various methods of fixation are available. When there is shearing type barton fracture buttress plate is the only choice of implant. Invention of locking plate revolutionized treatment of intraarticular fractures. But in comminuted fractures available designs of locking plate does not address all 3 columns, leading to usage of different plates for each column. OBJECTIVE: To evaluate the design of volar locking plate with polyaxial locking screws for addressing all columns particularly volar barton fragments METHODS AND MATERIAL: 35 patients aged from 18 – 60 years with distal radius fractures are operated with same implant. Patients were followed up at regular intervals 4weeks, 8 weeks,12 weeks followed by once in 3 months. Mean follow up period is 1 year. RESULT: Patients are evaluated with Gartland and Werley demerit point system. Out of 35 patients -28 patients had excellent outcome,7 patients had good outcome Conclusion: Volar locking plate with polyaxial screws can be implant of choice to address all the types of intrarticular distal radius fractures with good results.

Short term clinical and radiological results of volar locking plating in volar barton fractures

Introduction: Volar Barton's fracture is fracture-dislocation of radiocarpal joint with the intra-articular fracture involving the volar lip. Open reduction and internal fixation is the preferred method as this allows reduction under direct vision, stable internal fixation, shorter period of immobilization, and fast return of function. Materials and Methods: The study consisted a total of 20 patients who were operated in the Department of Orthopaedics, Government Medical College Srinagar during the period of 2019-2021. All the patients were managed by volar locking plating. Inclusion criteria were: age 18-60 years, both sexes, patient consenting for surgery and patients fit for anaesthesia. Exclusion Criteria were: associated factures of ipsilateral limb, delayed presentation more than 2 weeks, pathological fractures and open fractures. Results: Mean age of our patients was 27.3 years. The average palmar flexion was 72.5 degrees and the average dorsiflexion was 80.4 degrees. The mean supination was 82 degree and mean pronation at final follow up was 78 degrees. In the present study, the average radial inclination at final follow up was 17 degrees. All the 20 patients in this study had less than 5 mm radial shortening. Average palmar tilt at final follow up was around 7.5 degrees. 75% of the patient had excellent outcome based on Gartland and Werley score. Conclusion: Anatomical reduction of volar barton fractures is important to achieve good procedural outcomes. Volar locking plates have shown promising results in volar barton fractures.

Arc center distance as a novel quantitative radiographic parameter for volar Barton fractures.

The aims of this study were to investigate conventional radiographic parameters and introduce a novel parameter (arc center distance, ACD) for volar Barton fractures. Twenty-four cases of volar Barton fracture were retrospectively analyzed. We measured volar tilt angle (VTA), anteroposterior distance (APD), teardrop angle (TDA), and capitate-to-axis-of-radius distance (CARD) on lateral plain radiographs. The ACD was measured on the sagittal images of computed tomography scans. VTAs, APDs, TDAs, and CARDs were compared between the fractured and normal contralateral wrist. The area under the receiver operating characteristic curve was calculated for each parameter. TDAs did not differ significantly between the fractured wrists and the controls. On the other hand, VTAs, APDs, and CARDs were all significantly greater in the fractured wrists (mean values were 17.25°, 20.70mm, and -3.40mm, respectively). The area under the curve value was highest (0.943) for the ACD. When a cutoff value of 1.02mm was used as a threshold, a sensitivity of 100% and specificity of 80.95% were achieved. The mean values of conventional parameters (VTA, APD, TDA and CARD) in volar Barton fractures were presented. The ACD can be useful parameter for quantitatively evaluating volar Barton fractures.

Open Reduction and Internal Fixation with a Small T-plate for Volar Barton Fracture Management

Open Reduction and Internal Fixation with a Small T-plate for Volar Barton Fracture Management

Functional outcome of volar barton fracture distal end radius treated with plating

Background: More than 206 years have passed since Colles described the fracture of the distal end of the radius. Barton’s fracture, named after the American surgeon john rhea barton is a fracture of the distal end of radius that involves the dorsal or volar rim and extends into the intra articular region. As far as the treatments of volar barton fractures are concerned, it is one of the most challenging types. The main objective of treatment is to re-establish anatomic integrity and joint function. The purpose of the study is to evaluate the functional outcome of volar barton fracture of distal end radius treated with plating using mayo wrist score.Materials and Methods: The study was conducted in the department of orthopedics, Geetanjali medical college and hospital, Udaipur. 25 patients with volar barton fracture of distal end radius were included in study. The period of study was between January 2019 to June 2020. Minimal period of follow-up was 6 months and Functional outcome was evaluated using Mayo wrist score.Results: In our series, we had 64% excellent, 32% good, 4%, fair and no poor results using Mayo wrist score. Patients, who obtained excellent results, had normal regular activities and no pain. Range of motion was within the normal functional range. Radial length, volar tilt and articular step-off were within acceptable limits. Patients with good results had minimal residual deformities, pain and slight limitation of function. Patients with fair results, along with residual deformity, pain and limitation also had pain in the distal radio-ulnar joint and minimal complications. Few of their movements were less than that required for normal function.Conclusion: Our study concludes that fixation of volar Barton fracture of distal end radius treated with plating showed excellent functional outcome with early ROM and good grip strength without any major complications.

Correlation between functional and radiological outcome after surgical stabilization of volar Barton fracture with plating: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (p&amp;lt;0.0001) and radial deviation (p=0.005) of the wrist that underwent the surgical procedure after the fracture of the distal extremity of the radius. The radiological results were evaluated by modified Lidstrom criteria.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.&lt;/p&gt;

The Functional Outcome Volar Barton Fracture Treated by Open Reduction and Internal Fixation with T Plate – A Prospective Study

The Functional Outcome Volar Barton Fracture Treated by Open Reduction and Internal Fixation with T Plate – A Prospective Study

Dorsal Barton fracture is a variation of dorsal radiocarpal dislocation: a clinical study.

Dorsal Barton fractures may be better described as variants of dorsal radiocarpal dislocations. We aimed to better characterize these fractures by reviewing 111 patients in the ICUC® dataset who had a dorsally displaced, intra-articular distal radius fracture. We identified 13 patients with a dorsal Barton fracture on radiographs (dorsal articular margin fracture with radiocarpal subluxation and intact volar cortex). All patients with a dorsal Barton fracture had radial styloid involvement and volar cortical disruption that was subsequently identified on three-dimensional CT. Based on three-dimensional CT and intra-operative findings, none of the patients had classically described dorsal Barton fractures. All patients were treated using a volar exposure. A volar capsular tear was identified intra-operatively in three patients and the volar capsule repaired. This series supports the contention that dorsal Barton fractures are better characterized and treated as a variation of a dorsal radiocarpal dislocation. Level of evidence: IV.