A distal radial articular surface fracture with wrist joint dislocation (Barton fracture) is a specific type of distal radius fracture. This injury commonly occurs when a person falls with the wrist in dorsiflexion and the forearm in pronation, with the palm striking the ground. The force is transmitted through the carpal bones, impacting the dorsal articular surface of the distal radius, resulting in a fracture and dorsal displacement of the wrist joint (dorsal Barton fracture). Clinically, the presentation is similar to a Colles fracture, including a "silver fork" deformity and associated signs. X-ray imaging reveals the characteristic displacement.
If the fall occurs with the wrist in flexion and the back of the hand striking the ground, the fracture involves the volar articular surface of the distal radius, with the carpal bones dislocated volarly (volar Barton fracture). This type of fracture is less common and is often misdiagnosed or mistaken for a simple wrist dislocation. Careful review of the X-rays typically allows for an accurate diagnosis.
Figure 1 Typical displacement of fracture fragments in distal radial articular surface fractures with wrist joint dislocation (Barton fractures).
(1) Volar Barton fracture
(2) Dorsal Barton fracture
For both volar and dorsal distal radial articular surface fractures, initial treatment involves closed reduction with splint or plaster external fixation. If the fracture is highly unstable after reduction, open reduction with internal fixation may be required.