Volar Barton Wrist Fractures

Volar Barton fractures are a subtype of distal radius fractures where the front or volar half of the joint shears off and the wrist follows it. These are nearly universally considered operative fractures as there will be significant shortening and loss of function of the wrist and hand without surgical stabilization.

Occasionally, about once or twice a year, I am able to successfully treat a minimally displaced volar Barton’s fracture without surgery. This is the exception and not the rule.

When fixing these fractures, it is important to respect the joint and the likely impaction of the joint surface. Merely pushing it up with a plate is not enough, especially in fractures older than about a week. In order to reduce these, one must lift the volar or front cortex up to get access to the joint surface. Then it can be reduced from underneath and bone graft it if necessary, though it rarely is. Lastly, application of an appropriately designed volar locking plate will hold the fracture in stable position until it heals.