Barton Fracture (Symptoms,Causes and Treatment)

Barton fracture, also known as a Barton’s fracture or Barton’s lesion, is a specific type of wrist fracture that involves the distal radius bone. It is named after the American surgeon John Rhea Barton, who first described the fracture pattern in the early 19th century.

A Barton fracture occurs when there is a fracture of the distal radius bone along with dislocation or subluxation of the radiocarpal joint, which is the joint between the radius bone and the carpal bones of the wrist. The fracture typically occurs in the dorsal (back) or volar (palm-side) aspect of the distal radius.

Barton fractures are often caused by a high-energy force applied to the wrist, such as a fall onto an outstretched hand or a direct impact. They are more commonly seen in young adults involved in sports or high-impact activities.

The specific type of Barton fracture can be classified as either a dorsal Barton fracture or a volar Barton fracture, depending on the location of the fracture line. Dorsal Barton fractures involve the back of the distal radius, while volar Barton fractures involve the palm side.

Treatment of Barton fractures typically involves realigning the fractured bone and stabilizing it with the use of casts, splints, or surgery, depending on the severity of the fracture and the degree of joint displacement. The goal of treatment is to restore normal alignment, promote healing, and regain proper function of the wrist joint.

It’s important to consult with a healthcare provider or orthopedic specialist for a proper diagnosis and treatment plan if you suspect a Barton fracture or have any concerns related to your wrist injury.

This article covers the following topics :

What is a Barton fracture?

A Barton fracture is a specific type of fracture that occurs in the wrist. It involves a break in the distal radius bone, which is the larger of the two forearm bones that extends into the wrist joint. A Barton fracture is characterized by not only the fracture of the distal radius but also a dislocation or subluxation of the radiocarpal joint, which is the joint between the radius bone and the carpal bones of the wrist.

Barton fractures typically occur as a result of a high-energy force applied to the wrist, such as a fall onto an outstretched hand or a direct impact to the wrist. They are often seen in sports-related injuries or accidents involving significant trauma.

The fracture line in a Barton fracture can be classified as either dorsal or volar, depending on its location. A dorsal Barton fracture involves the back (dorsal) aspect of the distal radius, while a volar Barton fracture occurs on the palm side (volar) of the wrist.

Treatment of Barton fractures aims to realign the fractured bone and stabilize the joint to promote proper healing and restore normal function. This may involve non-surgical methods such as casting or splinting if the fracture is stable and the joint alignment can be maintained. However, in some cases, surgery may be necessary to realign the bones, fixate them with screws or plates, or address any associated ligamentous injuries.

It is important to consult with a healthcare provider or an orthopedic specialist for an accurate diagnosis, appropriate treatment, and guidance on rehabilitation and recovery for a Barton fracture.

What are the different types of Barton fractures?

There are two main types of Barton fractures based on the location of the fracture line: dorsal Barton fracture and volar Barton fracture. These classifications describe where the fracture occurs in relation to the distal radius bone and the wrist joint.

1-Dorsal Barton Fracture: In a dorsal Barton fracture, the fracture line extends along the dorsal (back) aspect of the distal radius. This type of fracture is typically caused by a force that impacts the back of the wrist, resulting in a break in the bone along with a dislocation or subluxation of the radiocarpal joint. Dorsal Barton fractures are often associated with a dorsal displacement of the fractured bone fragment.

2-Volar Barton Fracture: In a volar Barton fracture, the fracture line extends along the volar (palm-side) aspect of the distal radius. This type of fracture occurs when a force impacts the front of the wrist, causing a break in the bone and a dislocation or subluxation of the radiocarpal joint. Volar Barton fractures are typically associated with a volar displacement of the fractured bone fragment.

Both dorsal and volar Barton fractures can result in significant pain, swelling, and limited wrist mobility. The treatment approach for these fractures depends on the severity of the fracture, the degree of joint displacement, and individual patient factors. Treatment may involve non-surgical methods, such as casting or splinting, or surgical intervention to realign the bones and stabilize the joint.

It’s important to consult with a healthcare provider or an orthopedic specialist for an accurate diagnosis and appropriate treatment of a Barton fracture. They will assess the specific characteristics of the fracture and provide guidance on the most suitable management approach.

Who gets Barton fractures?

Barton fractures can occur in individuals of any age, but they are more commonly seen in certain groups of people who are more prone to wrist injuries or engage in activities that increase the risk of trauma to the wrist. These groups include:

1-Athletes: Barton fractures are frequently seen in athletes involved in sports such as football, basketball, soccer, skiing, and skateboarding, where falls or direct impacts to the wrist are common.

2-Active Individuals: People who engage in high-impact activities or have physically demanding occupations may be at an increased risk of Barton fractures. This includes construction workers, gymnasts, martial artists, and military personnel.

3-Young Adults: Barton fractures are more commonly observed in young adults who have higher levels of physical activity and participate in recreational sports.

4-Postmenopausal Women: Osteoporosis, a condition characterized by weak and brittle bones, is more prevalent in postmenopausal women. Weakened bones can increase the risk of fractures, including Barton fractures.

5-Individuals with Bone Disorders: Certain bone disorders, such as osteogenesis imperfecta (brittle bone disease), can make bones more prone to fractures, including Barton fractures.

It’s important to note that while these groups may be at a higher risk, Barton fractures can occur in anyone who experiences a forceful impact or trauma to the wrist. Prevention strategies, such as practicing proper safety measures during physical activities and maintaining bone health, may help reduce the risk of Barton fractures.

How common are Barton fractures?

Barton fractures are relatively uncommon compared to other types of wrist fractures. The exact prevalence of Barton fractures can vary depending on factors such as the population studied, geographical location, and the incidence of trauma-related injuries in a particular area.

Barton fractures account for a smaller percentage of all wrist fractures compared to more common fractures such as distal radius fractures or scaphoid fractures. However, they are still recognized as significant injuries that require appropriate diagnosis and treatment.

It’s important to note that the occurrence of Barton fractures may be higher in certain populations or individuals who engage in high-impact activities or sports. For example, athletes involved in contact sports or activities with a higher risk of wrist trauma may have a relatively higher incidence of Barton fractures compared to the general population.

If you suspect a Barton fracture or have concerns about a wrist injury, it is recommended to consult with a healthcare provider or an orthopedic specialist for an accurate diagnosis and appropriate management. They can assess the specific characteristics of the fracture and provide guidance tailored to your individual circumstances.

What causes this type of fracture?

Barton fractures typically occur as a result of a forceful impact or trauma to the wrist. The specific causes can vary, but common mechanisms of injury that can lead to Barton fractures include:

1-Falls: Falling onto an outstretched hand is a common cause of Barton fractures. This can happen during various activities, such as slipping on a wet surface, tripping, or falling from a height.

2-Sports Injuries: Participating in sports that involve contact, high-impact movements, or the risk of falls can increase the likelihood of sustaining a Barton fracture. Examples include football, basketball, skiing, skateboarding, and martial arts.

3-Motor Vehicle Accidents: In car accidents or motorcycle crashes, the forceful impact or sudden deceleration can result in wrist injuries, including Barton fractures.

4-Direct Trauma: Direct blows or impacts to the wrist, such as from a heavy object or during physical altercations, can cause Barton fractures.

It’s worth noting that the specific mechanism of injury for a Barton fracture can influence the type of fracture pattern and the location of the fracture line, whether it is dorsal or volar.

Individual factors, such as bone health, age, and underlying conditions, can also play a role in the likelihood of sustaining a Barton fracture. It is essential to practice appropriate safety measures during physical activities, wear protective gear when necessary, and seek medical attention if a wrist injury occurs to ensure a proper diagnosis and appropriate treatment.

What are the symptoms?

The symptoms of a Barton fracture may vary depending on the severity of the fracture, the extent of joint involvement, and individual factors. Common symptoms associated with Barton fractures include:

1-Pain: Pain is a primary symptom of a Barton fracture. The pain may be localized to the wrist and can be severe, especially with movement or pressure on the affected area.

2-Swelling: Swelling around the wrist joint is common after a Barton fracture. The swelling may be accompanied by bruising or discoloration of the skin.

3-Limited Range of Motion: A Barton fracture can cause stiffness and limited movement in the wrist. It may be difficult to bend or straighten the wrist fully, and there may be pain or discomfort when attempting to do so.

4-Deformity: Depending on the severity and displacement of the fracture, there may be visible deformity or an abnormal alignment of the wrist joint. This can result in an obvious misalignment or prominence of the bones.

5-Tenderness: The affected area may be tender to touch, and pressure on the injured site can elicit pain.

6-Difficulty Gripping or Holding Objects: A Barton fracture can affect hand and finger function, making it challenging to grip or hold objects firmly.

It’s important to note that these symptoms can also be present in other wrist injuries or conditions, so a proper medical evaluation is necessary to confirm the diagnosis. If you experience any of these symptoms following a wrist injury, it is recommended to seek medical attention for an accurate diagnosis and appropriate treatment.

How are Barton fractures diagnosed?

Barton fractures are typically diagnosed through a combination of clinical evaluation, physical examination, and medical imaging. Here is an overview of the diagnostic process:

1-Medical History: The healthcare provider will begin by taking a detailed medical history, including information about the nature of the injury, the mechanism of injury, and any associated symptoms.

2-Physical Examination: The healthcare provider will conduct a physical examination of the wrist to assess for signs of tenderness, swelling, deformity, and range of motion. They may also perform specific maneuvers to evaluate stability and joint function.

3-X-rays: X-ray imaging is the most commonly used diagnostic tool for evaluating wrist fractures, including Barton fractures. X-rays can reveal the presence of a fracture, the specific location and type of fracture, and any associated bone displacement or alignment issues.

4-Additional Imaging: In some cases, additional imaging studies may be ordered to further assess the fracture or obtain more detailed information. This may include a CT scan, MRI, or ultrasound, depending on the specific circumstances and the need for more comprehensive evaluation.

The combination of medical history, physical examination findings, and imaging results will help confirm the diagnosis of a Barton fracture and provide important information for treatment planning.

It’s important to consult with a healthcare professional or an orthopedic specialist for an accurate diagnosis. They will be able to evaluate your specific situation, interpret the imaging results, and recommend the most appropriate treatment approach based on the type and severity of the Barton fracture.

What questions might a healthcare provider ask to diagnose a Barton break?

When diagnosing a Barton fracture, a healthcare provider may ask a series of questions to gather relevant information and understand the nature of the injury. Here are some questions they may ask:

1-How did the injury occur? Gathering details about the mechanism of injury, such as a fall, sports-related incident, or direct trauma, can provide insights into the forces involved and potential fracture patterns.

2-When did the injury happen? Knowing the timeline helps determine the acuteness of the injury and guides the appropriate diagnostic and treatment approach.

3-Where is the pain located? Determining the specific location of pain can help identify the affected area of the wrist and potentially narrow down the possible fracture sites.

4-Is there swelling or bruising? Inquiring about swelling or bruising around the wrist can provide additional clues about the extent of soft tissue involvement and potential associated injuries.

5-Are there any limitations in wrist movement? Assessing the range of motion in the wrist and any associated pain or difficulty in movement helps evaluate the functional impact of the injury.

6-Have there been any previous wrist injuries or conditions? Understanding the medical history, including prior wrist injuries or conditions, can provide context and help differentiate between acute and chronic issues.

7-Are there any other symptoms or concerns? Inquiring about additional symptoms, such as numbness, tingling, or weakness in the hand or fingers, can help identify potential nerve involvement or complications.

8-Have you sought any prior medical treatment or interventions? Knowing if the individual has already received any medical attention or interventions for the injury can provide insights into the progression of symptoms and previous management attempts.

By asking these questions and conducting a thorough physical examination, healthcare providers can gather the necessary information to assess the likelihood of a Barton fracture and determine the appropriate diagnostic tests, such as X-rays or additional imaging studies, to confirm the diagnosis.

How is this kind of broken bone treated?

The treatment approach for a Barton fracture depends on various factors, including the specific type and severity of the fracture, the degree of displacement or instability, and the patient’s overall health and activity level. Treatment options for Barton fractures may include:

1-Immobilization: For non-displaced or minimally displaced fractures, immobilization with a splint or cast may be sufficient. This helps keep the wrist stable and promotes healing. The duration of immobilization will depend on the individual case, but it typically ranges from a few weeks to several weeks.

2-Closed Reduction: If the fracture is more displaced or unstable, a procedure called closed reduction may be performed. This involves manipulating the bones back into their proper alignment without the need for surgery. Following the reduction, the wrist may be immobilized with a splint or cast to allow for healing.

3-Surgery: In some cases, especially when the fracture is significantly displaced, unstable, or involves joint involvement, surgery may be necessary. The specific surgical technique will depend on the type and location of the fracture. Surgical options may include internal fixation (using screws, plates, or wires) or external fixation (using pins and an external frame) to stabilize the fractured bones and promote proper healing.

4-Rehabilitation: After the initial immobilization or surgical treatment, rehabilitation exercises and physical therapy may be recommended to regain strength, flexibility, and function in the wrist. This helps restore normal range of motion and facilitate the recovery process.

The choice of treatment approach is determined by the healthcare provider based on individual factors and the specific characteristics of the Barton fracture. It’s important to consult with an orthopedic specialist or healthcare provider for an accurate diagnosis and appropriate treatment plan tailored to your specific condition. They will consider the severity of the fracture, potential complications, and your overall health to guide the most suitable treatment approach for optimal recovery.

How long does it take to heal from a Barton fracture?

The healing time for a Barton fracture can vary depending on several factors, including the specific type of fracture, the severity of the injury, the individual’s overall health, and the chosen treatment approach. Generally, the healing process for a Barton fracture takes several weeks to a few months.

For non-displaced or minimally displaced fractures that are treated with immobilization, such as a splint or cast, the healing time may range from 6 to 8 weeks. During this time, the bones gradually mend together and regain their strength. However, it’s important to note that the complete resolution of symptoms and the return to normal activities may take longer.

In cases where surgical intervention is required, the healing time may be extended. After surgery, a period of immobilization is typically followed by rehabilitation exercises and physical therapy to restore wrist function. The total healing time for surgically treated Barton fractures can range from 8 weeks to several months, depending on the complexity of the fracture and the individual’s response to treatment.

It’s important to follow the guidance of your healthcare provider, adhere to the recommended treatment plan, and attend follow-up appointments to monitor the healing progress. They will be able to provide a more accurate estimate of the healing time based on your specific case and provide guidance on activities to avoid or modify during the healing period.

How can I reduce my risk?

Reducing the risk of a Barton fracture or any other type of wrist fracture involves taking precautions to prevent injuries. Here are some tips to reduce your risk:

1-Avoid falls: Take steps to prevent falls by ensuring a safe environment, removing hazards, and using appropriate safety measures such as handrails, non-slip mats, and adequate lighting.

2-Wear protective gear: When engaging in activities that carry a risk of wrist injury, such as sports or high-impact activities, wear protective gear such as wrist guards, gloves, or splints. These can help absorb impact and provide some protection to the wrist.

3-Practice proper technique: If you participate in activities that involve repetitive wrist movements or high impact on the wrist, such as gymnastics or weightlifting, make sure to learn and practice proper technique. This can help reduce excessive stress and strain on the wrist.

4-Strengthen your wrists: Engage in exercises that target wrist strength and flexibility. This can include wrist curls, wrist rotations, and grip exercises. Strengthening the muscles around the wrist can help provide stability and reduce the risk of injury.

5-Maintain bone health: Ensure you have a well-balanced diet rich in calcium and vitamin D, as these nutrients are important for maintaining strong bones. Regular exercise, particularly weight-bearing activities, can also help promote bone health.

6-Use caution when participating in high-risk activities: If you engage in activities that pose a higher risk of wrist injury, such as contact sports or activities with a risk of falls, use caution and be mindful of the potential risks. Consider proper training, supervision, and appropriate protective measures.

7-Take breaks and rest: If you engage in activities that involve repetitive wrist motions, take regular breaks and allow your wrists to rest. Prolonged and repetitive stress on the wrist can increase the risk of overuse injuries.

8-Seek medical attention for underlying conditions: Certain medical conditions or factors, such as osteoporosis or hormone imbalances, can weaken bones and increase the risk of fractures. If you have any underlying conditions that may affect bone health, seek appropriate medical attention and follow recommended treatments and lifestyle modifications.

Remember, prevention is key, but accidents can still happen. If you experience any symptoms or suspect a wrist injury, seek prompt medical attention for an accurate diagnosis and appropriate treatment.

What’s the outlook/prognosis for a Barton fracture?

The outlook or prognosis for a Barton fracture is generally favorable with appropriate treatment and rehabilitation. The specific prognosis can vary depending on factors such as the type and severity of the fracture, the individual’s overall health, the chosen treatment approach, and adherence to rehabilitation protocols. Here are some key points regarding the outlook for Barton fractures:

1-Healing and Recovery: With proper treatment, most Barton fractures heal well and allow for a return to normal function. The fractured bones typically consolidate and regain their strength over time. The duration of healing can range from several weeks to a few months, depending on the severity of the fracture and the chosen treatment approach.

2-Functional Recovery: Following the initial healing period, rehabilitation exercises and physical therapy are often recommended to regain wrist strength, flexibility, and function. These exercises aim to restore range of motion, improve muscle strength, and enhance functional abilities. With appropriate rehabilitation, many individuals can regain normal or near-normal wrist function.

3-Potential Complications: While the prognosis is generally good, there can be potential complications associated with Barton fractures. These may include stiffness, reduced range of motion, persistent pain, post-traumatic arthritis, malunion (improper alignment of fractured bones), nonunion (failure of bones to heal), or re-injury. The risk of complications can be minimized through proper treatment, adherence to rehabilitation, and close follow-up with healthcare providers.

4-Individual Factors: It’s important to note that the prognosis can vary among individuals based on their overall health, age, underlying medical conditions, and response to treatment. It’s essential to work closely with your healthcare provider to understand your specific prognosis and to follow their guidance regarding treatment, rehabilitation, and follow-up care.

5-Long-Term Outlook: With appropriate care, many individuals with a Barton fracture can achieve a good long-term outcome. However, it’s important to maintain a proactive approach to overall wrist health, including proper ergonomics, injury prevention strategies, and regular exercise to support ongoing strength and flexibility.

It’s crucial to consult with an orthopedic specialist or healthcare provider for an accurate diagnosis, appropriate treatment, and ongoing management of a Barton fracture. They can provide personalized information about the prognosis based on your specific circumstances and guide you through the recovery process.

What are the complications?

Complications associated with Barton fractures can vary depending on the severity of the fracture, the chosen treatment approach, and individual factors. Here are some potential complications that can arise:

1-Post-Traumatic Arthritis: In some cases, a Barton fracture can lead to post-traumatic arthritis, which is the development of arthritis in the affected joint due to the injury. This can cause pain, stiffness, and limited range of motion in the wrist joint.

2-Stiffness and Reduced Range of Motion: After a Barton fracture, stiffness and reduced range of motion in the wrist joint may occur. This can be due to scar tissue formation, immobilization during the healing process, or inadequate rehabilitation. Physical therapy and exercises are often recommended to restore wrist flexibility and function.

3-Malunion: Malunion refers to improper alignment of the fractured bones during the healing process. If the bones do not heal in the correct position, it can affect wrist function and lead to deformity or instability. In some cases, corrective surgery may be required to realign the bones and restore proper alignment.

4-Nonunion: Nonunion is a rare complication where the fractured bones fail to heal properly. This can occur if there is inadequate blood supply to the fractured area or if the bones are not immobilized properly during the healing process. Nonunion may require surgical intervention to stimulate bone healing.

5-Infection: Although uncommon, there is a risk of infection following a Barton fracture, especially if the fracture is open or if surgical intervention is required. Signs of infection include increased pain, swelling, redness, warmth, and discharge from the surgical site. Prompt medical attention is necessary if an infection is suspected.

6-Nerve or Blood Vessel Injury: In severe cases of Barton fractures or during surgical intervention, there is a small risk of injury to nearby nerves or blood vessels. This can result in nerve damage, loss of sensation, or impaired blood flow to the hand and fingers. Immediate medical attention is required if there are signs of nerve or blood vessel injury.

It’s important to note that complications are relatively rare with appropriate treatment, close follow-up care, and adherence to rehabilitation protocols. By working closely with your healthcare provider and following their recommendations, you can minimize the risk of complications and optimize your recovery.

When should I contact my healthcare provider?

You should contact your healthcare provider if you experience any of the following situations related to a Barton fracture:

1-Severe Pain: If you have severe or worsening pain that is not relieved by over-the-counter pain medications or prescribed pain relief.

2-Swelling or Redness: If there is significant swelling, redness, or warmth around the injured area, which may indicate an infection or inflammation.

3-Restricted Range of Motion: If you are unable to move your wrist or fingers normally, or if you notice a significant decrease in your range of motion.

4-Numbness or Tingling: If you experience persistent numbness, tingling, or weakness in your hand, fingers, or forearm, which could indicate nerve injury or compression.

5-Worsening Symptoms: If your symptoms, such as pain, swelling, or stiffness, worsen over time instead of improving.

6-Signs of Infection: If you notice signs of infection, such as increased pain, swelling, redness, warmth, or the presence of pus or discharge from the surgical site (if applicable).

7-Problems with Healing: If you notice delayed healing, such as persistent open wound, drainage, or non-healing of the surgical incision (if applicable).

8-Complications: If you experience any complications related to the fracture, such as instability, deformity, or ongoing functional limitations.

9-Concerns or Questions: If you have any concerns, questions, or uncertainties about your recovery, treatment, or rehabilitation process.

It’s important to seek prompt medical attention if you are experiencing any of these symptoms or concerns. Your healthcare provider will be able to evaluate your condition, provide appropriate guidance, and determine if any further intervention or treatment is necessary to ensure proper healing and recovery.