Barton's Fracture

- Discussion:     - distal radius fracture w/ dislocation of radiocarpal joint;     - most common frx dislocation of the wrist joint;     - comminuted frx of distal radius may involve either anterior or posterior cortex and            may extend into the wrist joint;            - frx dislocation or subluxation in which the rim of distal radius,                  dorsally or volarly is displaced with the hand and carpus;     - it often occurs along with a radial styloid frx;     - it differs from Colles' or Smith's Fracture in that the dislocation is the            most striking radiographic finding;            - in most cases, marginal frag is smaller than in anterior injury & often involves                  medial aspect where EPL crosses distal radius; - Radiographs:     - Non Operative Treatment:     - many of these frxs will fail nonoperative treatment;     - manipulative reduction is same as for Colles Fracture;     - stability of reduction of dorsal Barton frx is best obtained with            wrist extension to take advantaage of intact volar carpal ligament;     - immobilization for 6 weeks in short arm plaster cast; - Operative Treatment:     - is best treated by closed reduction, application of external fixation, followed by percutaneous pin insertion;     - if reduction is not anatomic, fraying of the tendon at this level may to late rupture;     - tendency to redisplace may require ORIF thru dorsal approach;