Barton fracture: Intra-articular fracture of the distal radius with subluxation or dislocation of the radiocarpal joint in the direction of the fracture fragment.
- Either the ventral or dorsal (anterior or posterior respectively) aspect of the radiocarpal joint is fractured. These ‘shear-type’ fractures involve the articular surface of the radius
- Both the anterior and posterior marginal fracture dislocations of the distal radius are uncommon injuries. Both of which are termed Barton fracture in the current literature, however Barton’s original description delineates the posterior marginal injury only.
- The anterior marginal injury has been later coined as a ‘volar Barton fracture’ or ‘reverse Barton fracture’ and is thought to be more common that Barton’s original dorsal type fracture.
1838 – John Rhea Barton described a ‘subluxation of the wrist consequent to a fracture through the articular surface of the carpal extremity of the radius.’ in his publication Views and treatment of an important injury of the wrist.
1943 – Lorenz Böhler reviewed 431 cases of fractures of the radius involving the wrist joint and found only 7 posterior and 11 anterior marginal fracture dislocations. The rarity of the posterior marginal fracture and the relatively more common occurrence of the anterior marginal fracture may account for some of the eponymous nomenclature confusion.
1977 – Thompson and Grant reviewed all distal forearm fractures at UCLA Hospital from 1972-1975. Ten anterior and five posterior marginal fractures were treated – constituting 2.3 per cent of all distal forearm fractures. [Clin Orthop Relat Res. 1977 Jan-Feb;(122):210-21]
- Barton fracture-dislocation
- Unstable Smith’s fracture
- Volar Barton or reverse Barton fracture
According to Barton’s original description, the term ‘Barton fracture‘ should be limited to those injuries involving the dorsal or posterior margins of the distal radius. [Although anterior marginal fractures were referred to, they were considered rare and did not provide the impetus for the description.]
Barton was criticized by Joseph François Malgaigne (1806-1865) in 1859, and later Lewis Atterbury Stimson (1844-1917) in 1883, for not using autopsy specimens. They hypothesised that Barton had most likely observed Colles-type fractures and paid tribute to Lenoir, a member of Dupuytren’s study group, who demonstrated this fracture type during autopsy.
- Barton, JR. Views and treatment of an important injury of the wrist. Medical Examiner. 1838;1:365–368.
- Nickson C. Stairs versus Wrist. LITFL 2018
- Thompson GH, Grant TT. Barton’s fractures-reverse Barton’s fractures. Confusing eponyms. Clin Orthop Relat Res. 1977 Jan-Feb;(122):210-21 [PMID 837611]
- Jupiter JB, Fernandez DL. Comparative classification for fractures of the distal end of the radius. J Hand Surg Am. 1997;22(4):563-571. [PMID 9260608]
- Fernandez DL, Jupiter JB. The Fracture of the Distal End of the Radius: An Historical Perspective. In: Fractures of the Distal Radius: A Practical Approach to Management. Springer. 2002:1-21
- Malgaigne J. A Treatise on Fractures. [Translated by John Packard] Philadelphia: Lippincott. 1859:53
- Stimson LA. A Treatise on Fractures. Philadelphia: H.C. Lea. 1883:453