Diagnosis

Partial articular fracture of the radius, involving dorsal rim (Barton's)

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Clinical examination

The patient should be evaluated for:

• Age
• Hand dominance
• Occupation
• Level of activity
• Quality of bone
• General medical condition

Options
1.  Simple
2.  Fragmentary
3.  With dorsal dislocation

1.  Simple

Partial articular, simple fracture of the radius, involving the dorsal rim (Barton's)

These partial articular fractures involve the dorsal rim of the distal radius and allow dorsal subluxation of the carpus.

These are classified by AO/OTA as 2R3B2.1.

The fracture fragments are often small and very close to the dorsal rim (representing osseous avulsion of the dorsal extrinsic ligaments).

There may be an associated ulnar injury. This is usually a fracture of the ulnar styloid process, but other ulnar fractures are possible.

Partial articular, simple fracture of the radius, involving the dorsal rim (Barton's) x-rays

2.  Fragmentary

Partial articular, fragmentary fracture of the radius, involving the dorsal rim (Barton's)

These partial articular fractures involve the dorsal rim of the distal radius and are associated with a lateral sagittal fracture (radial styloid). It is essential to reduce and stabilize these fractures, not only because of their articular component, but also to restore the radiocarpal stability.

These are classified by AO/OTA as 2R3B2.2.

There may be an associated ulnar injury. This is usually a fracture of the ulnar styloid process, but other ulnar fractures are possible.

Partial articular, fragmentary fracture of the radius, involving the dorsal rim (Barton's) x-rays

3.  With dorsal dislocation

Partial articular fracture of the radius with dorsal dislocation

These fractures are very similar to the previous subgroups but involve a greater degree of subluxation of the carpus, such that it is often completely dislocated dorsally.

In this case, these are classified by AO/OTA as 2R3B2.3.

There is usually a significant degree of soft-tissue damage in these injuries. The neurovascular structures are particularly at risk, especially the median nerve, because of the instability and wide displacement.

There may be an associated ulnar injury. This is usually a fracture of the ulnar styloid process, but other ulnar fractures are possible.

Partial articular fracture of the radius with dorsal dislocation x-rays