Barton's fracture
Background
- Fracture-dislocation of distal radius extending into radiocarpal joint
- Two types: volar and dorsal (based on direction of dislocation)
Clinical Features
- Wrist pain, usually after FOOSH injury
Differential Diagnosis
Distal radius fractures
- Colles' fracture
- Smith's fracture
- Barton's fracture
- Radial styloid fracture
- Distal radioulnar joint disruption
Distal radius fracture eponyms
| Eponyms | Description |
| Barton's | Fracture-dislocation of radiocarpal joint (with intra-articular fracture involving the volar or dorsal lip) |
| Chauffer's | Fracture of radial styloid |
| Colles' | Dorsally displaced, extra-articular fracture |
| Die-punch | Depressed fracture of the lunate fossa (articular surface) |
| Smith's | Volar displaced, extra-articular fracture |
Evaluation
- Assess for distal pulse, motor, and sensation
- Inspect skin for signs of open fracture
Imaging
Volar Barton's fracture
- PA
- Comminuted fracture of distal radial metaphysis
- Lateral
- Intra-articular fracture of volar or dorsal rim of radius
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Minimally displaced: sugar tong splint and ortho referral
Disposition
- Can be managed as outpatient
Admit
- Open fracture
- Signs of neurovascular injury
- Concern for compartment syndrome
Specialty Care
- Unstable requires ORIF
- >50% of radial articular surface
- Accompanying carpal subluxation
References
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