Definition
- characterized by frx of volar margin of the carpal surface of the radius which is associated with subluxation of radiocarpal joint
- similar to Smith’s type III
- both involve volar dislocation of carpus associated with intra-articular distal radius component
- it differs from Colles’ or Smith’s Fracture in that the dislocation is the most striking radiographic finding
- volar Barton’s is more common than dorsal Barton fractures
Mechanism of Injury
- usually result from a fall upon an outstretched arm
- leading to dorsiflexion stress & tension failure of volar lip of radius
- strong volar radiocarpal ligaments avulse the volar lip of the radius from the metaphysis
Nonoperative Treatment
- most of these fractures will require operative treatment
- if non operative treatment is attempt, be sure to immobilize the wrist palmar flexed which will tip the carpi away from the fractured volar surface
Operative Treatment
- ORIF is required for all displaced volar articular lip fractures
- even with initial acceptable reduction, recurrence of palmar subluxation is common
- strong proximal pull of the extrinsic wrist & digital flexors & extensors makes closed reduction difficult & predisposes joint to loss of position
Implants
- volar plates are well tolerated, & seldom need to be removed
- small T plate on the volar aspect
- plate is bent in mid portion to effect pre-bending effect
- ensure that the distal margin of the plate does not encroach on the articular surface (using image intensifier)
- slight dorsal articular penetration may be allowable
- begin with a proximal screw (3.5 cortical) placed into the distal side of the oval hole
- this applies compression to the periarticular fragments
- subsequently, insert the distal screw (4.0 cancellous) only if it is needed