Barton Fracture Research Articles

Advances in application of wrist arthroscopy in treatmem of Barton fractures

桡骨远端骨折尤其是高能量损伤引起的关节内粉碎性骨折常并发软骨塌陷、三角纤维软骨复合体(triangular fibrocartilage complex, TFCC)损伤、舟月韧带以及月三角韧带撕裂等软组织损伤,采用传统方法对此类损伤进行治疗效果并不理想,往往伴有腕关节僵硬、不稳、疼痛以及创伤性关节炎等晚期并发症。

Treatment of old Barton's fracture

Objective To analyze the etiology of old Barton's fractures and discuss the diagnostis strategies and treatment options. Methods Sixteen cases of old Barton's fracture(11 cases of volar fractures and 5 cases of dorsal fractures) were involved.Plain X-ray examines were combined with CT scan to determine type of the fractures.displacement of ioint surfaces and the severity of wrist joint dislocation.Eleven cases of volar Barton's fractures were fixed with T-shaped metallic plate via a volar-radial approach.Five cases of dorsal Barton fractures were treated with limited intemal fixation combined with external fixator via a distal dorsolateral incision. Results All 16 patients were followed-up for 10 to 36 months postoperatively.Bone union was seen in all cases.The volar tilting angle was 10°～15°(average 11.3°).The ulnar inclining angle Was 16°～25°(average 20°).There was no shortening of the radius.According to Mehara's evaluation for volar Barton's fractures.15 cases(93.8%)had obtained sarisfying results(excellent in 13 cases.good in 2 cases,fare in 1 case). Conclusions Open reduction and intemal fixation is an effective method to treat old Barton's fractures.CT scan is helpful in revealing fracture details.displaying joint surface displacement,and judging the accuracy of surgical reduction and fixation. Key words: Fractures.bone; Fracture fixation; Treatment outcome

A case of malunion after dorsal Barton fracture in a child

A case of malunion after dorsal Barton fracture in a child

Treatment of Barton's fractures by minimally invasive surgery

目的 探讨采用闭合复位内固定术和有限切开复位可吸收螺钉内固定治疗桡骨远端Barton骨折的可行性.方法 1990年5月-2004年5月,对25例桡骨远端Barton骨折的患者,采用微创手术治疗.其中16例在X线机透视下,采用手法复位克氏针内固定术(闭合复位内固定组);9例采用有限切开复位可吸收螺钉内固定术(有限切开内固定组).结果 术后23例获得6个月～1.5年随访,2例失访.闭合复位内固定组术后4～6周骨折达到骨性愈合,有限切开内固定组6～8周达到骨性愈合,其中1例出现骨性关节炎.按Deoliveiva腕关节功能评定标准:闭合复位内固定组优11例,良3例,可1例,优良率达93%.有限切开内固定组优4例,良3例,差1例,优良率达87%.结论 微创手术治疗桡骨远端Barton骨折,操作简单,创伤小,功能恢复满意。

Fractures of the Dorsal Articular Margin of the Distal Part of the Radius with Dorsal Radiocarpal Subluxation

Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation (Barton fractures) are well recognized, and substantial data are available to guide their treatment. In contrast, fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation (sometimes referred to as dorsal or reverse Barton fractures) are rarely mentioned, and there are very little data to guide their treatment. Twenty patients with a fracture of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation were evaluated. A spectrum of volar injuries was observed: two patients had torn volar ligaments; ten had a displaced, rotated volar marginal lip fracture; six had impaction of the volar aspect of the articular surface; and two had no appreciable volar injury. Fourteen of the twenty patients also had impacted central articular fragments. Eighteen patients underwent surgical reconstruction of the articular surface and application of dorsal buttress plates with use of a variety of surgical approaches. At the time of follow-up, the outcome was assessed radiographically and with use of the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. At an average of thirty months postoperatively, nineteen fractures had healed without substantial loss of alignment and one patient had recurrent dorsal subluxation after plate removal. The final average amount of wrist and forearm motion was 59 degrees of flexion, 56 degrees of extension, 87 degrees of pronation, and 85 degrees of supination. The average grip strength was 85% of that of the contralateral, uninjured hand. The final functional result according to the system of Gartland and Werley was rated as excellent or good for eighteen patients and as fair for two. The average modified Mayo wrist score was 75 points, and the average DASH score was 15 points. Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation are accompanied by a spectrum of volar injuries, including ligament injuries, avulsion fractures, and impaction of the articular surface. Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients. Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Operative Treatment of Intra-articular Distal Radius Fractures Using the Small AO External Fixation Device

A retrospective group study was done to evaluate the effect of the small AO external fixator in the management of acute intra-articular fractures of the distal radius. Between January 1995 and December 1996, 70 consecutive patients with articular fractures of the distal radius were treated by closed reduction and external fixation with small AO external fixators. The mean age at the time of surgery was 58.9 years (range, 14-87 years). There were 58 Colles' Barton's fractures and 12 Smith's Barton's fractures. The follow-up period was 104 months (range, 92-118 months). All fractures united in a mean of 5.8 weeks (range, 4-10 weeks). At the final follow-up, the average range of motion was 56.3 +/- 11.6 degrees in flexion, 58.6 +/- 10.7 degrees in extension, 21.5 +/- 4.2 degrees in ulnar deviation, 9.1 +/- 2.9 degrees in radial deviation, 71.5 +/- 8.5 degrees in pronation, and 67.3 +/- 9.2 degrees in supination. Compared with the normal side, the average grip force was 87 +/- 6%. The overall clinical and functional outcomes, according to the scoring system of Gartland and Werley, showed that 22 patients (31.4%) had excellent results, 36 (51.4%) had good results, 9 (12.9%) had fair results, and 3 (4.3%) had poor results. Closed reduction and external fixation with the small AO external fixator is useful and effective in the management of displaced comminuted articular fractures of the distal radius.

‘AO’ OR EPONYMS: THE CLASSIFICATION OF WRIST FRACTURES

Abraham Colles had the good fortune to describe the most common fracture about the wrist but, because its description was published in a provincial journal, it received little attention and was almost never referred to in his lifetime. The same can be said of Claude Pouteau who described the same fracture in another lesser-known medical journal. Robert Smith described the fracture that bears his name in 1847 although it had already been described by Jean-Gaspar-Blaise Goyrand some years before. Galeazzi's fracture had been described nearly 90 years earlier by Sir Astley Cooper and is also known as Dupuytren's and Piedmont fracture. To add to the conflicting nomenclature it is sometimes not clear whether a Smith's II fracture is a Barton's fracture or a reversed Barton's fracture. In the presence of all of this confusion it is not surprising that a Swiss group, Arbeitsgemeinschaft für Osteosynthesefragen, has classified wrist fractures into groups of As, Bs and Cs.

Treatment of intra-articular fractures

本期 是以关节内骨折为主要内容的重点刊,涉及下肢的胫骨平台骨折、髌骨骨折、 Pilon骨折、跟骨骨折及上肢的肩胛盂骨折、桡骨远端骨折的手术治疗.关节内骨折,特别是高能量的损伤由于骨折移位、关节塌陷及软组织损伤等增加了治疗的难度.治疗上根据关节内骨折的特点应做到:对骨折损伤正确判断,把握手术时机,应用微创技术,尽可能达到骨折的解剖复位及对线,最大限度恢复关节功能.特别强调关节内骨折的治疗要个体化。

Open Reduction and Internal Fixation of Volar Barton's Fractures: A Prospective Study

To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist. From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study. Special care was taken during surgery to achieve articular congruity. The injury was caused by motor vehicle accidents in 13 cases and by a fall in 3. All cases were type-B3 fractures: 10 were of the B3.3 subtype, 4 of the B3.2 subtype, and 2 of the B3.1 subtype. Most (12) cases were operated on within one week of injury, 3 in one to 2 weeks, and one in 2 to 3 weeks. All patients were assessed clinically and radiographically after a mean follow-up duration of 32.4 months (range, 12.0-65.0 months). Fractures healed after 7.0 to 10.0 weeks (mean, 8.8 weeks). Results of evaluations according to functional criteria were excellent in 9 cases, good in 5, and fair in 2. Radiocarpal osteoarthrosis developed secondary to trauma in 2 cases. There was no involvement of the median nerve in any of the 16 cases. Open reduction and internal fixation of volar Barton's fracture can restore articular congruity and result in good to excellent function.

Surgical treatment of volar Barton fracture

目的 介绍掌侧型Barton骨折的手术治疗.方法采用腕掌侧切口,直视下将骨折复位,应用AO-T型钢板内固定,无需外固定,早期功能锻炼.结果7例患者均获得6个月以上随访,无切口感染,平均骨愈合时间8周,功能评定优.结论掌侧型Barton骨折应用AO-T型钢板内固定是一种合理有效的方法,无需外固定,腕关节功能恢复好。

Operative treatment for Barton's fracture of the distal radius

目的 探讨桡骨远端Barton骨折的手术方法及疗效观察.方法对1999年6月至2002年3月收治的26例Barton骨折的病人,其中背侧Barton骨折12例,掌侧 Barton骨折14例,分别进行背侧及掌侧T形纯钛金属板钉内固定,术后进行早期功能锻炼.结果 26例全部得到随访,术后随访5～18个月.X线片显示桡骨远端骨折全部愈合,掌倾角7°～15°,平均10.2°,尺偏角18°～27°,平均20.2°.桡骨轴向无短缩,按Mehara关于掌侧Barton骨折功能评价[1],优18例,良6例,可2例,优良率达到92.3 % .结论对于桡骨远端Barton骨折,采用T形纯钛金属板钉内固定配合术后早期功能锻炼,可达到骨折准确复位及早期恢复腕关节功能的目的。

Antegrade intramedullary K-wire fixation for distal radial fractures.

Manual reduction and antegrade intramedullary K-wire fixation were performed for 29 selected Colles-type distal radial fractures in 29 patients. Severely comminuted intra-articular fractures and Barton's fracture were not included in this study. The tips of the K-wires supported an articular surface of the distal radius. Except for 1 case of skin irritation in the forearm, there were no complications related to tendon or nerve injuries or reflex dystrophy. There was no pin loosening, but protrusion of sharp tips of K-wires into the wrist joint occurred in 3 patients. Average volar tilt, radial shortening, and step-off at follow-up evaluation were 5 degrees, 2.6 mm, and 0.2 mm, respectively. These radiologic results were consistent with values reported in other pinning studies; however, radial shortening was not controlled effectively. Fourteen (48%) of 29 patients had radial shortening >3 mm. The advantages of this surgical procedure are the low occurrence rate of soft-tissue complications and prevention of dorsal angulation of fractures.

Cervical spine manipulation and the precautionary principle

Eponyms, whereas commonly used in hand surgery, are perhaps misused as often as they are used correctly. Many commonly used eponyms, such as Colles fracture, Barton fracture, Smith fracture, and Bennett fracture, were actually described decades before the development of radiographs. The goal of this article is to revisit the original descriptions of commonly used eponymous terms for distal radius and first metacarpal base fractures to provide clarity and enhance understanding of what these eponyms actually mean.

Complications Following Distal Radial Fractures

Union with deformity is the most common complication following a distal radial fracture1-5. The deformity may be extra-articular, characterized by loss of length and metaphyseal angulation; it may be intra-articular, involving either the radiocarpal or the radioulnar joint, or both; or it may be a combination of the two. Surgical treatment of a symptomatic malunion of the distal part of the radius has been recognized for more than 200 years. Resection of the distal aspect of the ulna for the management of pain at the distal radioulnar joint after a distal radial fracture, a procedure attributed to Darrach after his description in 19136, had been suggested by Desault in 17917 and again by Moore in 18808. In 1937, Campbell described a corrective osteotomy of the distal part of the radius with use of an interpositional bone graft obtained from the distal part of the ulna9. In 1945, Merle d’Aubigne and Joussement described a multiple-facet curved osteotomy without the need for an interpositional bone graft10. This concept is currently being revisited and will be described. A deformity following fracture of the distal part of the radius is not necessarily symptomatic. In fact, it is not uncommon for an older patient to have acceptable wrist and forearm function without pain even when there is an apparent deformity. Therefore, impairment of function rather than radiographic deformity is the reason to treat a distal radial malunion, and, consequently, the patient’s wrist and forearm function must be assessed. The most common deformity following a malunited extra-articular Colles type of fracture is the loss of the normal volar tilt of the articular surface in the sagittal plane, loss of ulnar inclination in the frontal plane, loss of length relative to the ulna, and …

The arthroscopic management of intra-articular distal radius fractures.

Intra-operative arthroscopy and fluoroscopy provide improved visualisation and guide the restoration of intra-articular distal radial fractures while minimising the operative dissection required for their stabilisation. Radial styloid fractures, distal radial fractures with dorsal, palmar or combined ulnar-sided "die punch" fragments, palmar and dorsal Barton's fractures, and various three- and four-part intra-articular fractures without significant bone loss or defect are especially suited for this technique. The experienced arthroscopist may wish to apply the technique to more severely comminuted intra-articular fractures. Bone defects may be approached through a limited dorsal incision traversing the 3rd dorsal wrist compartment. Arthroscopy and fluoroscopy may be used adjunctively to assess fracture reduction and fixation. Arthoscopy further facilitates initial treatment by allowing direct joint visualisation, debridement, the removal of small free intra-articular fragments, and the recognition and early treatment of wrist ligament injuries, particularly those not appreciated by X-ray evaluation

Clinicians' recognition of 10 different types of distal radial fractures.

This study concerned baseline performance in recognition of 10 different types of distal radial fractures. Verbal tasks of admitting knowing about fractures and Visual tasks were designed for each fracture type. The Verbal task of admitting knowing consisted of a description with the relevant distinctive features of the fracture. The surgical resident was asked whether he admitted knowing the particular fracture described. The Visual task consisted of X-rays for which the subject had to label the fracture or identify its distinctive features. The test was presented to 30 surgical trainees working in five teaching hospitals. On the Verbal task of admitting knowing, scores were statistically significantly higher (68% "yes") than on the Visual task (33% correct). Responses met our criterion of 80% correct for the following fracture types: Colles's, distal forearm, and Smith's fracture. For seven other fracture types (combination radius and scaphoid, radial styloid process, dorsal Barton's, volar Barton's, pilon, chauffeur's, and lunate load fracture), the 80% criterion was not met. Analysis of the incorrect answers on the Visual task indicated that the surgical residents tended to label unknown fracture types as Colles's or Smith's fractures. Furthermore, the residents tended to overestimate their own diagnostic competence (overconfidence bias) for several fracture types. It was concluded that to improve diagnosis, the relevant distinctive features of distal radial fractures should be taught.

女性のとう骨遠位端骨折に対する手術成績

The purpose of this study is to report the surgical results of distal radius fractures in females. Fifty-five female patients who were operated for distal radius fractures were studied. Three types of the fracture 47 colles type, 4 smith type, and 4 volar Barton fracture were seen Three types of fractures were reen; Colles type (41 patients), Smith type (4 patients), and Volar Barton type (4 patients). In the Colles type, 24 patients were treated by pinning, 11 patientes by plating, 7 patients by the Kpandji method, and 5 patients using external skeltal fixator. In the smith type, 2 patients were treated by pinning, and 2 patients by plating. In the Volar Barton fracture, all 4 patients were treated by plating. The follow-up range was from 4 months to 6 years and 3 months, averaging about 1 year and 9 months. Post operative results were evaluated using Saito's criteria.In the Colles type, 31 cases were excellent, 15 cases were good, and 1 case was poor. In the Smith type, 2 cases were excellent, and 2 cases were good. In the Volar Barton fracture, all 4 cases were excellent. Especially in the Colles type, plating is superior at general appreciation, subjective appreciation, and X-ray measurement, pinning is superior at range of motion, and hand grasping power, and Kapandji method is superior at keeping volar tilt. Three patients showed complications of cutanoous tunnel syndrome, 1 patient injury of the superficial branch of the radius nerve, and 1 patient tendon tear of abductor pollicis longus.

Complex Articular Fractures of the Distal Radius: Classification and Management.

Articular fractures of the distal radius require an anatomic reduction, as even minimal step-offs are associated with the development of osteoarthritis. Such fractures are classified on the basis of both the mechanism and the pattern of injury. The comprehensive classification of fractures established by Muller et al defines those occurring from a shearing mechanism and involving part of the articular surface as type B fractures. These are in turn subdivided into group B1 fractures, which involve the radial styloid (chauffeur's fracture); group B2, which involve the dorsal margin of the radius; and group B3, which involve the volar margin of the distal radius (Barton's fracture). Type B fractures are unstable and often require operative intervention. Articular fractures resulting from a compression force on the end of the radius are classified as type C. A group C1 fracture is a two-part fracture without metaphyseal comminution; group C2, a two-part fracture with metaphyseal comminution; group C3, a fracture with more than two pieces, with or without comminution. The operative tactic for compression fractures involves restoration of the four common fragments in sequence. This can often be accomplished by manipulative means alone or with limited exposure of the fracture fragments and stabilization with percutaneous Kirschner wires. Neutralization with an external fixator and use of an autogenous bone graft are often required.

Surgical treatment of 35 volar Barton fractures

35 patients with volar Barton fractures were treated operatively from 1985-1994. The injury was due to a high velocity motor vehicle accident in 20 patients. All fractures were closed without major carpal injuries. 11 fractures were type B3.1, 21 type B3.2 and 3 type B3.3. according to the AO classification. All fractures were openly reduced and internally fixated by small buttress plates and screws. In 31 cases, the median nerve was unaffected by the injury and was not explored or decompressed during surgery. The patients were assessed clinically and radiographically after mean 6 (2-10) years. According to the criteria of Pattee and Thompson (1988), 23 patients had excellent results, 10 good and 2 fair. Posttraumatic arthrosis was found in 12 patients and was related to the congruency of the articular surface achieved at surgery. We conclude that the median nerve, when not damaged or compressed, should not be explored or decompressed during surgery.

Ｉｎｔｒａｆｏｃａｌ Ｐｉｎｎｉｎｇ法を用いて整復したじょう骨遠位端関節内骨折の検討

We treated 16 patients (10 men and 6 women) with intra-articular fractures of the distal radius by intrafocal pinning which was reported by Kapandji at 1976. The age at surgery range from 17 to 77 years, mean 41.3 years. There were 12 communited Colles fractures, 2 volar Barton fractures, and 2 comminuted Smith fractures. Follow-up ranged from 2 to 33 months with a mean of 12.3 months.The roentgenographic changes of radial inclination, palmar tilt, ulnar variance, and step-off were measured just after pinning and at final follow-up. Roentgenographic results and clinical results were evaluated using Saito's criteria.Radial inclination averaged 24.6° after reduction and 22.6° at follow-up. Palmar tilt averaged 8.3° after reduction, changing to 9.0° at follow-up. Mean ulnar variance was 0.6mm and mean step-off was 2mm. These values did not change after reduction and at follow-up. Those values were within acceptable range after Saito's criteria. Clinical results were excellent in 7, good in 9. None showed fair or poor results.Intrafocal pinning has only been indicated for extra-articular fractures and intra-articular fractures with moderate dorsal comminution. Our surgical results justify our expanded indication for other comminuted fractures of the distal radius. We think that intrafocal pinning is the method of choice for extra-and intra-articular fractures of the distal radius.