Barton’s fracture

1. Barton’s Fracture

2. History and Physical 68 yo female presents after slipping and falling while getting out of the shower. Pt fell forward onto her outstretched hand, with her wrist extended. Pt complains of extreme pain in her left wrist, and denies hitting her head or any other injuries. T 97.6 P 98 BP 159/86 O2 97% Gen: In obvious pain but NAD MSK- obvious dorsal deformity/swelling to right wrist, limited range of motion in right wrist, 1+ radial pulse Neuro- limited flexion/extension right wrist, nl sensation throughout

3. Radiographs

4. Diagnoses: Barton’s Fracture D istal radius fracture w/ dislocation of radiocarpal joint

5. Pain Control Reduction of fracture, usually under conscious sedation Ortho consult needed, as non-op treatment usually fails S tability of reduction of dorsal Barton f x is best obtained with   wrist extension to take advantage of intact volar carpal ligament ED Management

6. M ost common fx dislocation of the wrist joint;     - comminuted fx of distal radius may involve either anterior or posterior cortex and        may extend into the wrist joint Fx dislocation or subluxation in which the rim of distal radius (dorsally or volarly) is displaced with the hand and carpus;     - it often occurs along with a radial styloid frx     - it differs from Colles' or Smith's Fracture in that the dislocation is the most striking radiographic finding More common for distal fragment to be displaced dorsally, although it can dislplace volarly also (volar Barton’s fx ) Pearls

7. More Images

8. http://www.wheelessonline.com/ortho/dorsal_bartons_fracture_dorsal_shearing_frx http://www.freebase.com/view/en/distal_radius_fracture http://myradnotes.wordpress.com/2008/06/ http://www.radiologyassistant.nl/en/476a23436683b References