Introduction
The wrist joint is also called a radiocarpal joint, a complex, modified ball and socket joint connecting the forearm and hand. It is responsible for flexion, extension, adduction, and abduction movements. Eight carpal bones and two bones of the forearm, that is, the ulna and radius, constitute to form the wrist joint. Extrinsic radiocarpal ligaments, joint capsule, scaphoid, and lunate fossa of the radius help to stabilize the wrist joint.
What Is Barton Fracture?
Barton’s fracture is called so because it was first described by John Rhea Barton in 1938. It is an intraarticular fracture of the rim of the distal radius, wherein the fracture extends into the wrist joint surface. Smith’s fracture and Colles' fracture are also wrist joint fractures, but they are extra-articular in nature. Barton’s fracture is a shear type of fracture. It occurs when a force of high velocity travels from the hand and wrist through the surface of the radius, forming the wrist joint and resulting in its subluxation or dislocation.
What Are the Types of Barton Fractures?
Barton’s fractures are classified based on the direction of dislocation:
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Dorsal or Posterior Fracture: The posterior aspect of the radiocarpal joint is fractured due to a high-velocity trauma.
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Volar or Reverse Barton’s fracture: It is the most common wrist fracture compared to dorsal fracture. It is also called palmer fracture. The radiocarpal joint is fractured on the anterior side. It may be due to trauma or avulsion, which results in tension failure because of the pull of the radiocarpal ligaments from the joint.
What Are the Causes of Barton Fracture?
Barton’s fracture is usually seen in young individuals, mostly males, and in elderly people, primarily females. Some of the causes of Barton’s fracture include:
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Direct trauma to the wrist due to a fall on an outstretched hand (FOOSH).
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Elderly women can be at risk for Barton’s fracture due to low bone density or osteoporosis.
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Injuries that cause a high-velocity impact, like road accidents and sports injuries.
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Manual workers or labor workers are susceptible due to their occupation.
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Tenderness at the site.
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The wrist hangs in an odd way, or the wrist appears bent, like a deformity.
What Are the Signs and Symptoms of Barton Fracture?
Signs and symptoms include:
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Presence of bruises around the wrist.
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Severe wrist pain and immediate swelling or a bump.
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Numbness in case of severe injuries due to nerve involvement.
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Inability to move the wrist or limited range of motion.
What Are the Complications of Barton Fractures?
Some of the complications of Barton’s fracture include:
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Stiffness of the Joint: Stiffness and pain reduction after treatment and recovery period; however, in some cases, the fracture can lead to permanent stiffness in the joint. Continuation of physical exercises would help in this regard.
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Post-traumatic Arthritis: It is a common complication in fractures that extend into the joint due to failure of reduction or incomplete alignment of the joint surface.
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Damage to the Nerve or Blood Vessels: High-velocity injuries may usually result in trauma to the surrounding nerves and blood vessels, resulting in numbness or circulation problems.
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Osteomyelitis: High risk for bone infections in case of open wrist injuries.
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Malunion: Failure in the proper alignment of the bones after surgery and rehabilitation.
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Carpal Tunnel Syndrome: It is characterized by pain, tingling sensation, or numbness in the arm and joints.
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Acute Compartment Syndrome: Inadequate blood supply can damage the nerves and muscles, and other organs leading to this syndrome.
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Complex Regional Pain Syndrome: Severe pain due to the irritation of the nerves following injury.
How Are Barton Fractures Diagnosed?
Immediate attention and care are required in cases of wrist injuries. A delay in treatment may cause complications or permanent damage to nerves or blood vessels. A complete medical history is taken by the doctor, followed by a physical examination to check the range of motion, strength, and sensation. Radiological investigations include:
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X-Ray: Frontal, lateral view X-rays to diagnose fractures and determine the associated dislocation. It can also be helpful in showing the bony irregularities and the amount of space between the fractured fragments.
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Computed Tomography (CT Scan): It is required in some cases for better evaluation as it provides a three-dimensional view of the fracture, which helps in planning surgical treatment.
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Magnetic Resonance Imaging (MRI): It is rarely recommended but is useful in diagnosing associated ligament or soft tissue injuries.
How Are Barton Fractures Managed?
Treatment of Barton’s fracture depends on the severity and nature of the fracture and the age of the patient. The non-surgical method includes:
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Closed Reduction: It is followed in cases of minor injuries wherein the doctor realigns the broken fragments and immobilizes them with a splint or a cast for a few weeks. Periodic monitoring with X-rays reassures the healing process. It is followed by physical exercise therapy.
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Open Reduction: Complex or severe fractures that cannot be managed by closed reduction or failures in closed reduction are treated surgically or by open reduction. The surgeon makes an incision on the wrist over the fractured bone to expose it, preserving the adjacent blood vessels and nerves. Alignment of the bones is done and fixed using metal screws or plates, rods, pins, or a combination of these techniques. Medications are prescribed to relieve pain and antibiotics to prevent infections, followed by rehabilitation or physical exercise therapy.
What Are the Precautions to Be Taken to Prevent Barton Fracture?
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Maintaining a healthy lifestyle with a proper diet and regular exercise.
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Grab bars can be installed in the bathrooms and railings for the stairs.
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Avoiding slippery surfaces or wearing appropriate shoes.
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Calcium and vitamin D supplements are to be taken.
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Elimination of any tripping hazards at home.
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Wearing wrist guards during sports activities like football, rugby, snowboarding, and skating.
Conclusion
Barton’s fracture is a shear-type fracture where the distal surface of the radius is fractured, with the dislocation of the wrist joint, which is its characteristic feature. It results from high-velocity trauma like vehicle accidents or sports injuries. It is associated with severe pain, swelling, and numbness in cases of neurological involvement. Minor fractures are managed by closed reduction, whereas severe cases require surgical treatment followed by physical therapy, and most of the patients will be able to recover back to normal within a few months.
