Open reduction and internal fixation of volar Barton’s fractures by polyaxial locking plates: a retrospective study
Keywords:Volar Barton’s fracture, Fracture fixation, Open reduction, Internal fixation
Background: A Barton’s fracture is a compression injury with a marginal shearing fracture of the distal radius. Conservative management of these fractures are highly unsuccessful with multiple complications. Locked plate and screw systems acts as single unit for fracture fixation, allows early mobilisation with good functional recovery.The objective of the study is to evaluate the functional and radiological outcome of volar Barton’s fractures treated with polyaxial locking plates.
Methods: Thirty six patients with volar Barton’s fractures, who underwent surgical treatment with polyaxial locking plate between June 2014 to June 2018, with a minimum one year of follow up. The fractures were classified according to Mehara’s classification and the outcome was evaluated using Pattee and Thompson criteria for outcome of wrist.
Results: We achieved 100 % union in all patients. Our results were excellent (61%), good (28%) and fair (11%). Our complications include superficial infection, finger stiffness, radiocarpal arthritis, extensor tendon rupture and Sudeck’s osteodystrophy.
Conclusions: Polyaxial locking plates restore articular congruity of the volar Barton’s fracturess and give best possible results with least complication rates, provided the technique is carefully performed.
Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691–7.
Barton DW, Griffin DC, Carmouche JJ. Orthopedic surgeons’ views on the osteoporosis care gap and potential solutions: survey results. J Orthop Surg Res. 2019;14(1):72.
Wright TW,Horodyski M, Smith DW. Functional outcome of unstable distal radius fractures: ORIF with a volar fixedangle tine plate versus external fixation. J Hand Surg Am. 2005;30(2):289-99.
Waever D, Madsen ML, Rölfing JHD, Borris LC, Henriksen M, Nagel LL, et al. Distal radius fractures are difficult to classify. Injury. 2018;49(1):29-32.
Mauck BM, Swigler CW. Evidence-Based Review of Distal Radius Fractures. Orthop Clin North Am. 2018;49(2):211-22.
Masood, F, Sah RK, Sarfaraz AH. Faisal’s technique to closely manage volar Barton’s fracture: a pilot study. Annals King Edward Medical University. 2018;24(1):124-8.
Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radius fractures. J Bone Joint Surg Am. 2006;88(9):1944-51.
Gerostathopoulos N, Kalliakmanis A, Fandridis E, Georgoulis S. Trimed fixation system for displaced fractures of distal radius. J Trauma. 2007;62(4):913-8.
Cao J, Ozer K. Failure of volar locking plate fixation of an extraarticular distal radius fracture: a case report. Patient Saf Surg. 2010;4(1):19.
Al-Mouazzen, L., Chou DT, Kyriakopoulos G, Hambidge J. Polyaxial versus Uniaxial Volar Locking Plate for Distal Radial Fractures. J Orthop Surg. 2014;22(1):9-12.
Mehara A, Rastogi S, Bhan S, Dave P. Classification and treatment of volar Barton fractures. Injury. 1993;24(1):55-9.
Pattee GA, Thompson GH. Anterior and posterior marginal fracture-dislocations of the distal radius. An analysis of the results of treatment. Clin Orthop Relat Res. 1988;231:183-95.
Freeland AE, Luber KT. Biomechanics and biology of plate fixation of distal radius fractures. Hand Clin. 2005;21(3):329-39.
Aggarwal AK, Nagi ON. Open reduction and internal fixation of volar Barton's fractures: a prospective study. J Orthop Surg. 2004;12(2):230-4.
Kotian P, Mudiganty S, Annappa R, Austine J. Radiological Outcomes of Distal Radius Fractures Managed with 2.7mm Volar Locking Plate Fixation-A Retrospective Analysis. J Clin Diagn Res. 2017;11(1):9-12.
Rausch S, Klos K, Stephan H, Hoffmeier K, Gras F, Windolf M, et al. Evaluation of a polyaxial angle-stable volar plate in a distal radius C-fracture model- a biomechanical study. Injury. 2011;42(11):1248-52.
Wall LB, Brodt MD, Silva MJ, Boyer MI, Calfee RP. The effects of screw length on stability of simulated osteoporotic distal radius fractures fixed with volar locking plates. J Hand Surg Am. 2012;37(3):446-53.
Vaiss L, Ichihara S, Hendriks S, Taleb C, Liverneaux P, Facca S. The utility of the fluoroscopic skyline view during volar locking plate fixation of distal radius fractures. J Wrist Surg. 2014;3(4):245-9.
Fredrick MA, Canale ST, Beaty JH. Campbell’s operative orthopaedics. 13th ed. Philadelphia: Elsevier; 2016: 3006.