Barton Fracture

Excerpt

Philadelphia orthopedic surgeon John Rhea Barton first described a Barton fracture. 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. 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.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. Non-union of barton fracture is less likely because the distal radius has a large proportion of cancellous bone. On the other hand, an anatomical reduction is required as malunion and wrist arthritis are common following barton fractures. The wrist's ability to deviate ulnarly for a power grab depends on the distal radius articular surface's volar and ulnar slope. The volar surface of the distal radius is comparatively flat. The volar radiocarpal ligaments originate from a ridge of the distal radial border. It's crucial to comprehend that the distal radial cortical edge slopes laterally toward the ulnar. From proximal to distal, the lunate facet's ulnar volar border slopes 3mm vertically making a difficult internal fixation. The lunate fossa appears as a teardrop sign on the lateral radiograph. Failure to support this lunate border would lead to incompetent short radiolunate ligament resulting in radiocarpal instability.