Barton fracture

Barton's fracture: Description, Causes and Risk Factors:A Barton's fracture is an intra-articular fracture of the distal radius with dislocation of the radiocarpal joint.Types:Volar-type Barton's is a fracture-dislocation of the volar rim of the radius. This type is the most common.
  • Dorsal-type Barton's is a fracture-dislocation of the dorsal rim of the radius. Dislocation of the radiocarpal joint is the hallmark of Barton's fractures. These are shear type fractures of the distal articular surface of the radius with translation of the distal radial fragment and the carpus. These fractures have a great tendency for redislocation and malunion. They usually require operative treatment.
Barton fractures result from high-energy impact transmitted to the articular surface of the radiocarpal joint (e.g. FOOSH — `fall no outstretched hand'). The volar or dorsal rim fractures depending on whether the wrist is in volar flexion or dorsiflexion, respectively.Alternatively, a volar rim fracture may result from tension failure and avulsion due to the pull of the strong radiocarpal ligaments when the wrist is forecfully dorsiflexed on impact.In the young, the injury takes the form of an anterior fracture-separation of the lower radial epiphysis. Whatever the type of the fracture, the carpus and the lower fragment are displaced forwards and more or less proximally. The ulnar styloid process may or may not be involved and impaction seldom occurs. The cortex of the anterior aspect of the lower radius is thin and brittle and often becomes comminuted.Barton's fractureSymptoms:Symptoms of a Barton's Fracture:Sudden pain on impact.
  • Pain and difficulty when trying to move the wrist.
  • The wrist may appear deformed.
  • Swelling.
  • Tenderness.
  • Bruising.
Diagnosis:Lateral wrist radiographs best demonstrate the degree of articular involvement and displacement. The fracture is also easily seen on a PA radiograph of the wrist.An X-ray will be required to confirm the diagnosis and the extent of the injury.Barton's fractureTreatment:Treatment of a Barton's fracture may depend on the size of the fracture fragment and the degree of displacement. Get an orthopedics review early as operative repair is often necessary.For non-displaced Barton's fracture:Consider sugar-tong splint with wrist in neutral position.For displaced Barton's fracture:Closed reduction under procedural sedation.
  • If stable, consider sugar-tong splint with wrist in neutral position.
  • If unstable or inadequately reduced, open reduction and internal fixation (ORIF).
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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