On the other hand, an anatomical reduction is required as malunion and wrist arthritis are common following barton fractures. ![]() Non-union of barton fracture is less likely because the distal radius has a large proportion of cancellous bone. This preserved relationship between the radius and carpus is what distinguishes the Barton fracture from other types of distal radius fracture/dislocations. The distal radius fracture may involve either the volar or dorsal cortex. Volar and dorsal barton fractures are subclassified based on the fracture pattern. As compared to the dorsal rim fracture, the volar barton fracture occurs more frequently. There is no disruption of the radiocarpal ligaments, and the articular surface of the fractured distal radius remains in contact with the proximal carpal row. It is a fracture of the distal radius which extends through the dorsal aspect of the articular surface with associated dislocation of the radiocarpal joint. >10 degrees dorsal angulation >5 mm shortening significant comminution) 1.Philadelphia orthopedic surgeon John Rhea Barton first described a Barton fracture. Open reduction and internal fixation (ORIF) is considered when the fracture is unstable, and/or unsatisfactory closed reduction is achieved (i.e. The cast extends from below the elbow to the metacarpal heads and holds the wrist somewhat flexed and in ulnar deviation 4 - for those of you familiar with Australian rules football this position is reminiscent of the position adopted when holding a ball in preparation for a kick. The vast majority of Colles fractures can be treated with closed reduction and cast immobilisation. Location of the medial fracture line: does it involve the radioulnar joint In addition to noting the presence of a fracture a number of features should be sought and commented upon: An associated ulnar styloid fracture is present in up to 50% of cases.Ī pronator quadratus sign is generally seen. If dorsal angulation is severe enough, a dinner fork deformity may be described.There is also usually impaction with resultant shortening of the radius. ![]() Dorsal angulation of the distal fracture fragment is present to a variable degree (as opposed to volar angulation of a Smith fracture). The fracture appears extra-articular and usually proximal to the radioulnar joint. The plain radiographic series often comprises an AP and a lateral view however, it is not uncommon for an oblique view to be included. Plain films usually suffice, although if there is a concern of intra-articular extension, then CT may be beneficial. As such, in clinical practice, the use of the term Colles fracture with an appropriate description of any associated injuries is sufficient in most instances. ![]() One of the more popular is the Frykman classification system, although it fails to distinguish between Smith and Colles fractures as it is based on AP radiographs 2,3. Radiographic featuresĪ number of classification systems exist for distal forearm fractures. Most fractures are therefore dorsally angulated and impacted. The proximal row of the carpus (particularly the lunate and scaphoid) transfers energy to the distal radius, both in the dorsal direction and along the long axis of the radius. Most Colles fractures are secondary to a fall on an outstretched hand (FOOSH) with a pronated forearm in wrist extension (the position one adopts when trying to break a forward fall).
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