Bartons fracture volar

case of the week

1. A 75 year old woman tripped and fell over a small dog, and landed
heavily on an outstretched right hand. Her wrist joint is visibly
swollen but without obvious angulation or deformity. Tenderness is
around all of the wrist but maximal over the distal radius.
•Describe and interpret the lateral x-ray?
•What management is likely to be required ?

2. www.radiologykey.com

3. The intra-articular nature of the fracture, with instability and
the potential for carpal subluxation mean that most patients
with this injury are managed surgically. This usually means
open reduction and internal fixation. All such patients should
be referred to orthopaedics even if a conservative approach is
taken in an older patient with an undisplaced fracture. The aim
is to regain joint stability and minimise the risk of long term
radiocarpal joint arthritis.
Though the fracture line is easy to appreciate, it is important to
accurately describe and identify this injury. This is a so called
“Barton’s fracture”, in this case of the volar (or palmar) type. The
fracture line runs horizontally through the distal radius when
viewed on the AP film, while on the lateral film the fracture line
appears vertical. In this case the fragment created by the fracture
lies on the volar (palmar) surface and has been displaced
proximally with a step present in the articular surface confirming
joint instability. Articular involvement, whether displaced or not,
characterises Barton’s fractures. In the less common dorsal
Barton’s fracture the fracture still runs into the articular surface
but the fragment that has the potential to displace is on the dorsal
surface.