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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.
For these same photos without the arrows, click here
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Barton fractures. Wheeless' Textbook of Orthopaedics
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