Artikel
The Dorsal Barton Fracture Revisited
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Autoren
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Jesse Jupiter
- Massachusetts General Hospital, Harvard Medical School, Boston, United States
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Background: The anterior shearing fracture-dislocation long termed the "Bartons'" or "Reversed Bartons'" fracture of the distal radius by definition involves the carpual subluxation inferiorly along with a wedge segment of the volar aspect of the radius. The dorsal aspect of the radius will be intact and the radiocarpal ligaments will have ruptured but their volar components remain attached to the carpus. Given that the volar ligaments are considerably stronger than their dorsal counterparts, can the same really be the case with the dorsal equivalent or rather are those lesions truly radiocarpal fracture dislocations?
Methods: We evaluated over 500 consecutive distal radius fractures treated operatively as part of the ICUC APP. All fractures were documented with pre and postoperative readiographs and CT scans and followed for a minimum of one year.
Results and Conclusions: We were unable to locate any instance of a case fulfilling the descriptive criteria of a dorsal Barton lesion (AS/ASIF classification 23-B-2). These criteria being a dorsal marginal distal radius fracture including a posterior subluxation of the carpus and an intact volar cortex. Those cases which at first may have appeared consistent with such a injury will be found to have a component of the volar articular surface displaced with maintenance of some continuity of the volar capsular ligaments from the fracture fragment onto the subluxated carpus. These cases without a volar fracture component should be considered radiocarpal fracture-dislocations which are more complex injuries.
We did identify what we termed "pseudo" dorsal lesion which was a sagittal fracture of the radial side of the articular surface with displacement of the carpus with the radial side ligament intact as the fragment displacement includes the volar rim of the radius.
The term "Bartons" fracture should be confined to the volar injury with the apparent dorsal equivalent rather a complex intrarticular fracture or a radiocarpal fracture-dislocation.
