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Purpose The aims of this study were to investigate conventional radiographic parameters and introduce a novel parameter (arc center distance, ACD) for volar Barton fractures. Methods Twenty-four cases of volar Barton fracture were retrospectively analyzed. We measured volar tilt angle (VTA), anteroposterior distance (APD), teardrop angle (TDA), and capitate-to-axis-of-radius distance (CARD) on lateral plain radiographs. The ACD was measured on the sagittal images of computed tomography scans. VTAs, APDs, TDAs, and CARDs were compared between the fractured and normal contralateral wrist. The area under the receiver operating characteristic curve was calculated for each parameter. Results TDAs did not differ significantly between the fractured wrists and the controls. On the other hand, VTAs, APDs, and CARDs were all significantly greater in the fractured wrists (mean values were 17.25°, 20.70 mm, and - 3.40 mm, respectively). The area under the curve value was highest (0.943) for the ACD. When a cutoff value of 1.02 mm was used as a threshold, a sensitivity of 100% and specificity of 80.95% were achieved. Conclusions The mean values of conventional parameters (VTA, APD, TDA and CARD) in volar Barton fractures were presented. The ACD can be useful parameter for quantitatively evaluating volar Barton fractures.

Background: More than 206 years have passed since Colles described the fracture of the distal end of the radius. Barton’s fracture, named after the American surgeon john rhea barton is a fracture of the distal end of radius that involves the dorsal or volar rim and extends into the intra articular region. As far as the treatments of volar barton fractures are concerned, it is one of the most challenging types. The main objective of treatment is to re-establish anatomic integrity and joint function. The purpose of the study is to evaluate the functional outcome of volar barton fracture of distal end radius treated with plating using mayo wrist score.Materials and Methods: The study was conducted in the department of orthopedics, Geetanjali medical college and hospital, Udaipur. 25 patients with volar barton fracture of distal end radius were included in study. The period of study was between January 2019 to June 2020. Minimal period of follow-up was 6 months and Functional outcome was evaluated using Mayo wrist score.Results: In our series, we had 64% excellent, 32% good, 4%, fair and no poor results using Mayo wrist score. Patients, who obtained excellent results, had normal regular activities and no pain. Range of motion was within the normal functional range. Radial length, volar tilt and articular step-off were within acceptable limits. Patients with good results had minimal residual deformities, pain and slight limitation of function. Patients with fair results, along with residual deformity, pain and limitation also had pain in the distal radio-ulnar joint and minimal complications. Few of their movements were less than that required for normal function.Conclusion: Our study concludes that fixation of volar Barton fracture of distal end radius treated with plating showed excellent functional outcome with early ROM and good grip strength without any major complications.

Introduction- Distal radius reconstruction needs aggressive operative intervention is still a debate among researchers & orthopaedic surgeons. There is very little role of non operative management in geriatric unfit patients. Revolution of implants & techniques advocated the best clinical outcome. Material & methods- Prospective research study is conducted at G.S. medical college Hapur, in department of orthopaedics. 20 patients of volar Barton fractures between the age group of 20 to 50 years were included in the study and treated with volar locking plate. out come of study was evaluated by using the Gartland & Werly score modified by Sarmiento & patient rated wrist Evaluation (PRWE) score. Results- Mean palmar flexion was 74 degree, dorsi flexion was 84 degrees observed, average supination & pronation was 85 & 80 degrees respectively. Radial & ulnar deviations average 10 and 25 degrees observed. 85% of patient had loss of radial inclination less than 10 degrees. All the patient had less than 5 mm radial shortening. Loss of palmar tilt less than 6 degrees was observed. More than 90% of the patients had excellent to good outcome based on Gartland & Werley score. Conclusion- Volar plating reproducible & proven method of choice in majority of Volar Barton factures of radius irrespective of comminution & fragments separation. Keywords: Volar Barton fracture, volar plate, osteosynthesis

Background: The objective of the study was to evaluate the functional and radiological outcomes after open reduction with internal fixation of volar Barton’s fracture of the wrist and compare their outcomes.Methods: Total of 30 cases of volar Barton fractures were operated by open reduction and internal fixation with plating. Mean follow up period was 6 months. Patients were assessed both radiological and functional outcome and compare between the two outcomes.Results: All fractures were healed in a mean period of 7 weeks (range 6-9 weeks). The mean disabilities of the arm, shoulder and hand (DASH) score was 13.21 points (range: 10.3 to 30), thus confirming the patient’s good functional capacity. The higher the DASH score was (i.e. the worse the functional result), the smaller were the flexion (p=0.01), pronation (p=0.03), supination (pConclusions: The radiographic results did not influence the DASH score. There was no statistical relationship between the DASH score and the radial height or the volar tilt or the radial tilt of the distal extremity of the operated radius.

Objective: The objective of the study was to assess the outcome of Salter- Harris type III distal radius fracture fixed using the principle of buttressing and avoiding screw insertion through the physis. Materials and Method: Eight school going children in the age group of 11-16 years with volar Barton fractures were treated with a volar plate using the buttress principle without inserting screws in the distal fragment. Patients were evaluated over a period of 18 months. Clinical evaluation was done using the Green O’Brien criteria and radiological evaluation using the Sarmiento criteria. Results: The average union time was two months. All the patients had good to excellent functional outcome with full extension and flexion. Conclusion: Buttress plating of volar Barton fractures in the adolescent age group is an excellent technique to achieve satisfactory outcome without violation of the physis.

Malunion following a neglected volar barton fracture can cause severe functional impairment owing to changes in normal anatomic and biomechanical relationships of the distal radius. These malunions, if mature can be treated by intra-articular osteotomies or the salvage procedures. But in nascent malunions, these procedures cannot be performed as the solid bony consolidation is absent and there is severe soft tissue contracture. In the present study, two-stage procedure was presented for the treatment of nascent neglected volar barton fracture presenting after 5 weeks, and treated primarily with gradual distraction and secondarily with open reduction and internal fixation with locked distal radius plate along with bone graft. Complete bony healing occurred in 6 months and Mayo wrist score improved from 31 to 85. At final follow-up after 2 years, visual and analog pain scores reduced from 68 to 11 and range of motion was 80 extension to 70 flexion along with near normal full grip strength along with mild wrist arthrosis. Surgical treatment of neglected fractures of distal radius can substantially improve wrist and hand functions, but rarely restores the limb to normal.

The purpose of this study is to report the surgical results of distal radius fractures in females. Fifty-five female patients who were operated for distal radius fractures were studied. Three types of the fracture 47 colles type, 4 smith type, and 4 volar Barton fracture were seen Three types of fractures were reen; Colles type (41 patients), Smith type (4 patients), and Volar Barton type (4 patients). In the Colles type, 24 patients were treated by pinning, 11 patientes by plating, 7 patients by the Kpandji method, and 5 patients using external skeltal fixator. In the smith type, 2 patients were treated by pinning, and 2 patients by plating. In the Volar Barton fracture, all 4 patients were treated by plating. The follow-up range was from 4 months to 6 years and 3 months, averaging about 1 year and 9 months. Post operative results were evaluated using Saito's criteria.In the Colles type, 31 cases were excellent, 15 cases were good, and 1 case was poor. In the Smith type, 2 cases were excellent, and 2 cases were good. In the Volar Barton fracture, all 4 cases were excellent. Especially in the Colles type, plating is superior at general appreciation, subjective appreciation, and X-ray measurement, pinning is superior at range of motion, and hand grasping power, and Kapandji method is superior at keeping volar tilt. Three patients showed complications of cutanoous tunnel syndrome, 1 patient injury of the superficial branch of the radius nerve, and 1 patient tendon tear of abductor pollicis longus.

Background: Distal radius fractures are coomonly seen and have various treatment methods available in literature hence, a clear consensus could not be reached as to the most ideal modality of management. With advent of buttress plates, open plating has become a treatment of choice in young adults whereas Kirschner wire fixation with external fixator application have achieved good results in osteoporotic and medically compromised patients. Methods: Twenty eight patients of distal Radius fractures with volar Barton pattern came to us were either treated by open reduction and plating (16cases) and 12 cases were treated by Kirschner wire fixation with external JESS fixation, with an average follow-up of 18 months (range, 12-24 months). Results: All the patients had union achieved without any major complications in plating patients (12 out of 16) and 10 out of 12 cases of Kirschner wires with JESS (p=.05). Conclusion: Surgical techniques discussed here are the two standard procedures with a long follow up, also in the literature are proven to be effective treatment modalities, and are found to give the best possible result with least complication rates. Despite the fact that each technique has its own advantages and side effects, whereas results from the plating treatment seem to be best suited for patients who have minimal commination and are heavy workers and need to join their working soon. Whereas the Kirshner wire and JESS was suited for comminuted fractures and osteoporotic fractures. Key words: Volar Barton’s fracture, Buttress plate, External fixation, JESS distractor, Kirschner wire