Reverse Barton's fractures: injury's characteristic, features and the results of surgical treatment

Reverse Barton’s fractures are very frequent type of intraarticular distal radius fractures. These fractures, being extremely unstable injury, require careful decision making concerning treatment strategy and continue to be an actual issue for general discussion.The aim of the study is to describe reverse Barton’s fractures in general, to review tactical and technical aspects of treatment and to analyze the results of volar locking plate fixation of these type of fractures.Material and Methods. We analyzed 68 patients (41 female and 27 male) with reverse Barton’s fractures treated in the period from 2017 to 2021 using volar locking plate fixation. The mean age was 41,7±5,3 years (33-51 years). The right hand was involved in 40 (58,8%) patients, and theleft was involved in 28 (41,2%) cases. The patients were followed-up for a mean of 22,9 weeks after the surgery, with the minimal follow-up of 3 months.Results. Primary union of distal radius was achieved within 5 to 8 weeks after the surgery in all cases. There were no perioperative complications. Consolidation’s accuracy in terms of volar tilt, radial height and radial inclination as well as functional results (flexion/extension of the wrist, forearm’s supination/pronation, grip strength and QuickDASH-9 score) were evaluated during follow-up period. After 3 months 92,6% of patients had an excellent results, 7,4% - good and satisfactory.Conclusions. The treatment of reverse Barton’s fractures is very difficult challenge for orthopedic surgeons. It is necessary to keep in mind - these fractures are extremely unstable, so that surgical treatment is the method of choice. Volar locking plating of reverse Barton’s fractures seems to be the optimal option in terms of stable fixation with excellent anatomical and functional results.