MANUAL MINORS
Reverse Barton’s fracture, also known as volar Barton’s fracture, is a variant of Barton’s fracture affecting the distal radius. It is characterised by volar (towards the palm) displacement of the distal radius fragment, along with partial dislocation of the radiocarpal joint. This injury typically occurs due to trauma, such as a fall onto a flexed hand.
Diagnosis
The diagnosis is based on:
Severe pain and deformity in the wrist, particularly on the palmar side.
Swelling and tenderness over the radiocarpal joint, with significant limitation of movement.
X-rays showing volar displacement of the distal radius fragment and partial dislocation of the joint. In complex cases, a CT scan may be useful to better visualise the extent of the fracture.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Smith’s Fracture | Volar displacement of the distal radius fragment without significant dislocation of the radiocarpal joint. |
Colles’ Fracture | Dorsal displacement of the distal radius fragment (opposite to reverse Barton’s). |
Wrist Dislocation | Joint displacement without distal radius fracture. |
Wrist Sprain | Pain without evidence of fracture on radiographic images. |
Emergency Management
Immediate immobilisation of the wrist with a splint or cast to prevent further displacement of bone fragments.
Application of ice to reduce swelling and administration of analgesics or anti-inflammatory drugs to control pain.
X-rays to confirm the fracture and assess the degree of displacement or dislocation of the radiocarpal joint.
In cases with significant dislocation, a closed reduction under local anaesthesia may be attempted, though most cases require surgical management.
Definitive Treatment
Definitive treatment is usually surgical, due to the instability of the fracture:
Internal fixation with plates and screws to stabilise the volar fragment of the radius and correct the dislocation of the radiocarpal joint.
Open reduction if proper alignment cannot be achieved with closed methods.
After surgery, the wrist is temporarily immobilised, followed by a rehabilitation programme to restore wrist and hand mobility and strength. Complications may include joint stiffness, post-traumatic arthritis, and chronic pain if proper alignment and stabilisation are not achieved.
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