A Study of Surgical Management of Volar Barton’s Fractures Using Ellis Plate

Abstract

BACKGROUNDThe distal end of radius fractures continue to pose a therapeutic challenge. Post-traumatic osteoarthrosis decreased grip strength, and endurance, as well as limited motion and carpal instability, are the complications because of intraarticular and extra-articular malalignment 1 Barton's fracture was named after the American surgeon John Rhea Barton. Barton's fracture is a fracture of the distal end of the radius that involves the articular surface of distal radius and is usually accompanied by subluxation or luxation of the radiocarpal joint. These fractures may result from high-or low-energy injuries, and they account for approximately 1.2 % to 4.2 % of distal radial fractures. Barton's fractures are classified into volar or dorsal Barton's fractures based on the site and shifting the direction of fragments. According to AO classification, volar Barton's fractures are classified as type B3 fractures of the distal radius. Conservative treatment is usually unsuccessful and fraught with complications, such as early osteoarthrosis, deformity, subluxation, and instability. ORIF with a volar Ellis plate system is currently practised for the treatment of volar Barton's fracture as it results in good reduction and provides immediate stability. Moreover, the patients can be mobilised early and quickly potentially reducing wrist stiffness. RESULTSAll cases were followed up periodically during the period 2016 to 2018 at 1, 3, 6, 12 months postoperative period, and results evaluated at the end, and scored by Gartland and Werley scoring system. 11 (55%) had an excellent result, 7 (35%) had good result, 1 (5%) had fair and 1 (5%) had a poor result. CONCLUSIONEllis plates gave successful results for the volar Barton's distal radius fractures. This method, which is effective in anatomic realignment, allows early joint motion, owing to its fixation strength.Close placement to joint interface and screwing capability in different orders are its biomechanical superiorities.The volar approach provides both access with minimal surgical trauma on distal radius and fixation with a better adoption to surrounding tissues. In the subjects of our study, a successful anatomic alignment was acquired with the volar approach, regardless of the direction of fracture angulation. The patients who were young adults in the majority went back to their daily activities with 90% recovery. These Ellis plates not only provide restoration of radial length but also help in stabilizing palmar angulation. They maintain intraarticular congruity thus reducing radiocarpal arthritis and decrease in grip strength. At last, not the least they also provide quicker recovery and better functional range of movement and provide better fixation in an osteoporotic bone.

Do Variable Locking Plates Provide Better Functional and Radiological Outcomes in Volar Barton Fractures?

“…Based on Gartland and Werley's outcome, the majority (65%) of the study population had excellent outcomes, 30% had good outcomes and only 5% had fair outcomes. A similar result was found by Kolla et al [ 16 ] with excellent Gartland and Werley outcomes in 55%, good in 35%, fair in 5%, and poor in 5% of their study population. Another study by Kundu A et al [ 15 ] with similar results to the present study found excellent outcomes in 70%, good in 16%, and fair in 14%.…”

“…A study by Kundu et al [ 15 ] found that 30 patients were treated with volar locking plate system where 46.6% were male subjects and 53.33% were female and the average age was 42 years ranging from 18 to 64 years and had right-side injury in the majority. Another study by Kolla et al [ 16 ] included 20 cases with volar Barton fractures with the majority of subjects in the 31 to 40 age group (45%) followed by 41 to 50 and 20 to 30 years at 25% each respectively. Males (80%) were affected more than females (20%) and the left side (65%) was more commonly injured than the right side (35%).…”

“…The present study showed hypertrophic scar and superficial infection in 5% each and 2.50% had complex regional pain syndrome. Kolla et al [ 16 ] found arthritis of the wrist joint in 15%, malunion fracture in 10%, and extensor pollicis longus tendon irritation in 5% due to long screw placement through the outer cortex irritating the tendon and one patient showed complex regional pain syndrome. The overall complication reported in Kundu et al [ 15 ] was 18%.…”

Outcome of volar Barton fractures of distal radius managed with open reduction and internal fixation with volar locking plate

“…These observations are comparable to the previous studies. 15,16,[18][19][20] Superficial wound infection was the most common complication in the present study, and was dealt with regular dressings and culture specific antibiotics. Deep infection was seen in two patients and both of them needed early implant removal at three months.…”

“…There is contrasting literature on the age and gender predilection for volar Barton fractures. 15,16 At the final follow-up the authors observed a mean flexion of 67.47°±4.8°, mean extension of 71.52°±3.98°, mean radial deviation of 8.45°±2.6°, mean ulnar deviation of 27.56°±2.9°, mean pronation of 72.65°±2.3° and mean supination of 76.35°±3.67°. These observations are comparable to the studies by previous researchers.…”