MANUAL MINORS
Barton’s fracture is an intra-articular fracture of the distal radius, characterised by displacement of the articular surface along with a partial dislocation of the radiocarpal joint. There are two types: dorsal Barton’s fracture (more common, with dorsal displacement of the fragment) and volar Barton’s fracture (with displacement towards the palm). This injury often occurs from falls onto an outstretched hand, with the wrist in flexion or extension.
Diagnosis
The diagnosis is based on:
Severe pain and deformity in the wrist, with significant swelling and limited movement.
Instability of the wrist due to the partial dislocation of the radiocarpal joint.
X-rays showing the displacement of the articular fragment of the radius and associated dislocation. In some cases, a CT scan may be required to better assess the fracture and plan surgical intervention.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Colles’ Fracture | Dorsal displacement of the distal radius fragment without dislocation of the radiocarpal joint. |
Smith’s Fracture | Volar displacement of the distal radius fragment without significant joint dislocation. |
Wrist Dislocation | Joint displacement without distal radius fracture. |
Wrist Sprain | Pain without evidence of fracture on X-rays, with joint stability. |
Emergency Management
Immediate immobilisation of the affected wrist with a splint or cast to prevent further displacement.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatory drugs to control pain.
X-rays to confirm the type of fracture and determine the degree of dislocation.
If significant displacement is present, a closed reduction under local anaesthesia or sedation may be attempted, but due to joint instability, many Barton’s fractures require surgical management.
Definitive Treatment
Definitive treatment is usually surgical, as Barton’s fracture is generally unstable:
Internal fixation with plates and screws to stabilise the fracture and restore the anatomy of the radius and radiocarpal joint.
In some cases, reduction of the radiocarpal joint dislocation may be required during surgery.
After surgery, the wrist is temporarily immobilised, followed by a rehabilitation programme to restore hand and wrist mobility and strength. Complications can include joint stiffness, chronic pain, or post-traumatic arthritis if the joint is not properly restored.
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