Clinical investigation of conservative treatment for volar Barton fracture

Objective:To discuss the indication and outcome of volar Barton fracture treated by nonoperative method. Methods:Twenty-three cases of volar Barton fracture treated by closed method included 8 male and 15 female with an average age of 52.2 years,ranging 16 to 84 years. Among them,16 cases showed subluxation of the carpus(15 cases were Mehara typeⅠ,1 case was Mehara type Ⅲ)by radiographs except the other 7 cases. By the experimentation in 32 cadavers,the injury of dorsal radiocarpal ligament was supposed to be a very important cause of the subluxation of the radiocarpal joint. The criteria of Pattee and Thompson was used to evaluate the outcome of the treatment. Results:Twenty-three patients were followed up for 7 to 70 months,11 cases gained satisfactory outcome(1 case as excellent,10 cases as good),12 cases gained unsatisfactory outcome(5 cases as fair, 7 cases as poor). Five of 7 cases without the subluxation of the carpus by the radiographs gained satisfactory outcome. Six of 16 cases with the subluxation of the carpus gained satisfactory outcome. Conclusion:①The result of reduction will influence the outcome of the treatment,the step on articular surface shoud be less than 2 mm after reduction. ② Nonoperative method is recommended if volar Barton fractures are not associated with subluxation of the carpus. ③Nonoperative method can be tried first if the fractures associated with the subluxation of the carpus, however operation is recommended when the articular step is more than 2 mm.