Barton Fracture in a Soccer Player

While playing soccer, a 24-year-old man fell on his outstretched hand, felt a "pop," and immediately noticed a deformity of his wrist. He was in severe pain when he presented to the emergency department.

Anteroposterior and lateral radiographs of the wrist showed a distal radius fracture with dorsal dislocation of the radiocarpal joint.

One of the most common fracture dislocations of the wrist, the Barton fracture usually extends into the wrist joint. The fracture can involve either the dorsal or volar portion of the distal radius but, by definition, has an associated dislocation of the carpus, with proximal and either dorsal or volar displacement. Often, a radial styloid fracture is also present.

A Barton fracture differs from a Smith or Colles fracture because of the associated proximal carpal row dislocation. In a Barton fracture, the radial fracture fragment is generally smaller than the fracture fragments seen in Smith and Colles fractures.

Most Barton fractures are managed nonoperatively with manipulative reduction, followed by immobilization for 6 weeks. For unstable fractures, reduction with pin insertion or application of an external fixator may be necessary.

In this patient, the alignment and stability of the wrist after manipulative reduction was adequate, and a cast was placed on the wrist in extension. After 6 weeks, the cast was removed. He then underwent 6 weeks of physical rehabilitation and returned to playing soccer within 3 months.

(Case and photographs courtesy of Douglas Beall, MD, of Edmond, Okla, and John Whyte, MD, of Silver Spring, Md.)