Barton Fracture Wrist

Written By: Chloe Wilson BSc (Hons) Physiotherapy
Reviewed By: SPE Medical Review Board

A Barton fracture is a rare but serious injury that affects the wrist, specifically the distal radius.

With a Barton’s fracture, there is both a fracture and a dislocation at the wrist.

It often occurs due to high-impact trauma and can significantly impact wrist stability and function if not treated properly.

In this article, we’ll explore what a Barton fracture is, the different types, causes, symptoms, and how it’s diagnosed and treated. We’ll also look at ways to prevent this injury and what to expect during recovery.

What Is a Barton Fracture?

A Barton fracture is a type of wrist fracture where there is a break in the distal radius, the long bone on the outer forearm.

In most cases, a triangular portion of bone breaks off the distal radius.

It is an intra-articular fracture, meaning it involves the joint surface where the radius bone meets the wrist at the radiocarpal joint. Unlike some other wrist fractures, with a Barton wrist fracture there is also dislocation of the radiocarpal joint, but the wrist ligaments usually remain intact.

This type of distal radius fracture is named after Dr. John Rhea Barton, an American surgeon who first described this injury in the early 19th century. Dr. Barton was a pioneering orthopedic surgeon, and his work laid the foundation for understanding and treating wrist fractures effectively.

Types of Barton Fracture

There are two main types of Barton fractures:

Barton Fracture Causes

A Barton fracture is usually caused by high-energy direct trauma to the wrist, such as:

• Sports Injuries: High-impact sports like football, basketball, or snowboarding can lead to wrist fractures.
• Motor Vehicle Accidents: Sudden, forceful impact during a collision can cause this type of injury.
• Industrial Accidents: Falling or being struck by heavy equipment can also result in a Barton fracture.
• Falls: Landing on an outstretched hand, particularly with the palm facing down, is a common cause, particularly in the elderly

Risk Factors

Certain factors can increase the likelihood of a Barton fracture, including:

• Osteoporosis: Weak, brittle bones are more prone to fractures from even minor trauma.
• Age: Older adults are at higher risk due to decreased bone density.
• Gender: Women, particularly post-menopausal women, are more likely to develop fractures because of bone loss.
• High-Risk Activities: Participation in contact sports or activities with a high risk of falling increases the chance of injury.

Symptoms Of Barton Fractures

The symptoms of a Barton fracture are similar to other wrist fractures and may include:

• Immediate Pain: around the wrist joint at the time of injury, often severe
• Swelling and Bruising: at the wrist and forearm
• Deformity: A noticeable change in the shape of the wrist
• Limited Mobility: Difficulty or inability to move the wrist or hand
• Tingling or Numbness: If the fracture affects nearby nerves

Diagnosing Barton Fracture Wrist

Diagnosing a Barton fracture typically involves the following steps:

• History: Your doctor will ask you about the mechanism of your injury, when and how it occurred and what symptoms you have had
• Physical Examination: They will assess your wrist for deformity, swelling, and range of motion.
• X-Rays: Standard imaging to identify the type and extent of the fracture.
• CT Scan or MRI: In some cases, advanced imaging may be used to assess joint involvement and soft tissue damage.

Differential Diagnosis

A Barton fracture can sometimes be mistaken for other wrist injuries. Conditions that need to be ruled out include:

• Colles Fracture: A fracture of the distal radius with dorsal (backwards) displacement without joint dislocation.
• Smith's Fracture: A fracture of the distal radius with volar (forwards) displacement but without the dislocation seen in Barton fractures.
• Scaphoid Fracture: A break in one of the small wrist bones, which may present with similar pain but different imaging findings.
• Wrist Sprain: Soft tissue injuries can mimic the symptoms of a fracture but lack the bone involvement visible on imaging.

A thorough examination and appropriate imaging are crucial for an accurate diagnosis and effective treatment plan.

When to See a Doctor

If you experience severe pain, visible deformity, or loss of function in your wrist after a trauma, seek medical attention immediately. Delaying treatment with a Barton Fracture can lead to complications such as permanent wrist instability or arthritis.

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Barton Wrist Fracture Treatment

The aim of Barton fracture treatment is regain full, pain-free range of motion and strength in the wrist so that you can return to all your usual activities. The treatment for a Barton wrist fracture depends on the severity of the injury:

Non-Surgical Treatment

• Immobilization: Initially, a splint or cast is applied to stabilize the wrist. In minor cases with no displacement, a cast may be sufficient, and will need to be worn for at least 6 weeks while the fracture heals.
• Pain Management: Anti-inflammatory medications e.g. ibuprofen can help reduce pain and swelling.

Surgical Treatment

In most cases, Barton fractures are extremely unstable, so they usually require surgery:

• Open Reduction and Internal Fixation (ORIF): Surgery starts with realigning the bone fragments and then securing them in place with plates and screws. Following surgery, the wrist is immobilised in a splint for 5-10 days. Success rate of 90-95%
• External Fixation: For severe fractures, an external frame may be used to stabilize the wrist. Success rate of 80-85%

Post-treatment, physical therapy is essential to regain strength and range of motion in the wrist.

Prognosis

With proper treatment, most people recover well from a Barton fracture. Recovery time varies depending on the severity of the injury and whether surgery was required. Mild cases may heal within 6–8 weeks, while more severe fractures can take several months of rehabilitation.

Early diagnosis and treatment are key to avoiding long-term complications like arthritis or chronic pain. Most people return to their usual activities.

Prevention

While accidents can’t always be avoided, you can reduce your risk of a Barton fracture by:

• Wearing Protective Gear: Use wrist guards during high-risk sports or activities.
• Improving Bone Health: Maintain a diet rich in calcium and vitamin D to keep your bones strong.
• Preventing Falls: Use handrails, wear non-slip footwear, and keep walkways clear of hazards.

Barton Fracture Summary

A Barton fracture is a complex wrist injury that requires prompt medical attention. Whether caused by a fall, sports accident, or high-energy trauma, this injury can significantly impact wrist function if left untreated. Fortunately, with advances in surgical and non-surgical treatment, most people can achieve a full recovery.

Barton fractures are a rare type of wrist fracture, accounting for less than 2% of distal radius fractures. The most common type is Colles fractures.

You may also be interested in the following articles

• Smith’s Fracture
• Wrist Tendonitis
• Ulnar Styloid Fractures
• De Quervain Tenosynovitis

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Related Articles

Medical & Scientific References

1. Barton Fracture. National Library Of Medicine
2. Barton Fracture. Radiopaedia
3. Volar Barton’s Fractures With Concomitant Dorsal Fracture In Older Patients. The Journal Of Hand Surgery
4. Open Reduction and Internal Fixation of Volar Barton Fracture: A Clinical Study. Journal Of Orthopedics Traumatology and Rehabilitation

Page Last Updated: January 28th, 2025
Next Review Due: January 28th, 2027

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