Barton Fracture

General Considerations

• Intra-articular fracture of the distal radius with subluxation/dislocation of the wrist
• The lunate maintains its relationship with the fracture fragment
• May involve the volar aspect of the radius (sometimes called “reverse Barton fracture”) or the dorsal aspect
• Volar type is more common
• Most common fracture-dislocation of the wrist

Clinical Findings

• Dorsal Barton’s fracture usually results from fall on an out-stretched hand
• Volar-type is caused by the same mechanism as a Smith fracture
• Result is deformity at wrist joint
• Pain, tenderness, swelling and decreased range of motion

Imaging Findings

• Conventional radiographs are the study of first choice
• Fracture is wedge-shaped and extends obliquely on the lateral view into the radiocarpal joint
• Carpal bones and hand maintain their relationship with the fracture fragment, separating from the remainder of the radius
• Frequently associated with ulnar styloid fractures
• CT if further definition is required

Differential Diagnosis

• Colles fracture-extra-articular fracture of the distal radius with dorsal angulation
• Smith fracture-a fracture of the distal radius with palmar angulation
• May have intra-articular component, but dislocation is not a feature as in Barton fracture

Treatment

• Most require operative treatment

Prognosis

• May re-dislocate
• Malunion

Barton's Fracture-Dislocation of the Wrist. The frontal radiograph shows a
fracture of the distal radius (red arrow) and ulnar styloid (white arrow). The lateral radiograph demonstrates a dorsal, wedge-shaped, intra-articular fracture of the
distal radius (yellow arrow), with which the carpal bones (green arrow) have dislocated posteriorly.
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Barton fractures. Wheeless' Textbook of Orthopaedics