Adolescent Volar Barton Fracture with Open Physis treated with Volar Plating using Buttressing Principle

We observed an unusual type of volar Barton fracture in the pediatric age and performed open reduction and internal fixation of the fragment, using the buttress plate in consecutive children. We report the radiological and clinical outcomes after follow-up for at least 3 years. From March 2008 to September 2014, nine consecutive children were treated by buttress plating. Their mean age at the time of injury was 13.1 years. All of the fractures were metaphyseal fractures in the coronal plane and typical Salter–Harris II fractures in the sagittal plane. After accurate reduction of the fragment, a cortical screw was inserted in the proximal area until the maximum compressive force against the fragment was obtained. Then, one or two locking screws were added adjacent to the initial cortical screw. No screw was fixed in the distal fragment. All evaluations were done at least 3 years postoperatively with a mean follow-up of 48.8 months. At final follow-up, the radial inclinations, volar tiltings, and ulnar variances were 23.2°±1.78° (98.7% of contralateral side), 9.4°±2.12° (98.4% of contralateral side), and –1.56±0.88 mm (93% of contralateral side), respectively. All radiological parameters of the distal radius were not significantly different from the contralateral values. The flexion–extension arc was 140.56°±5.27°, and the pronation–supination arc was 165.00°±8.29°. The grip strength was 26.67±5.56 kg. All clinical outcomes except the flexion–extension arc were similar to those of the normal side, with statistical significance. A volar Barton type injury can occur in the pediatric age involving the physis, and the buttress plating that is used in adults is also a useful treatment method. However, there is little information on this injury, and it was difficult to compare treatment outcomes with other methods. Because of the rarity of the injury, a larger, multicenter prospective comparative study is required to further explore appropriate treatment options, long-term outcomes, and complications. Level of Evidence: Therapeutic, Level IV.

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Certain fracture patterns in children/adolescents would be better called ‘Barton equivalent’ fractures

Cha,

Shin,

et al. 2024

Journal of Pediatric Orthopaedics B

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We have encountered consecutive children/adolescents with a volar Barton fracture (VBF) pattern without involving the physis. These were managed by buttress plating; thus, we would like to report the radiological and clinical outcomes through retrospective case series and suggest the revisiting of the ‘VBF category’ in this population. We screened children/adolescents with a diagnosis of trauma to the bony structures in the wrist from 2008 to 2019. Of these patients, 16 who met our inclusion/exclusion criteria were investigated. At the final follow-up performed at least 2 years postoperatively, radiologic and clinical outcomes were evaluated. The mean age at the time of injury was 12.88 years old. At the final follow-up, the volar tiltings, radial inclinations and ulnar variances were 10.13°, 20.88° and −0.50 mm, respectively. None of these radiologic parameters were significantly different from the contralateral values, except the radial inclination. The mean visual analog scale score was 0.38. The mean range of motion arcs were 136.56° and 157.81° in the flexion-extension and pronation-supination arcs, respectively, and the grip strength was 22.00 kg. The mean modified Mayo Wrist Score was 92.8. The radiologic and clinical outcomes compared with the contralateral side were not significantly different from those in a previous report. A VBF pattern without involving the physis in the child/adolescent population was treated satisfactorily by buttress plating. Thus, including the previously reported ‘SH-II in sagittal plane’ injuries, the current injury pattern would be better called a ‘Barton equivalent’ fracture. Level of Evidence: Level IV, retrospective case series.

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Adolescent Volar Barton Fracture with Open Physis treated with Volar Plating using Buttressing Principle

Cited by 3 publications

References 5 publications

Pediatric Distal Radius Fractures

Pediatric Distal Radius Fractures

Buttress plating for volar Barton fractures in children: Salter–Harris II distal radius fractures in sagittal plane

Certain fracture patterns in children/adolescents would be better called ‘Barton equivalent’ fractures

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