Fracturas del margen articular dorsal de la parte distal del radio…(I)

Santiago A. Lozano-Calderón, MD1, Job Doornberg, MS1 and David Ring, MD1

1 Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org

Background: Fractures of the volar articular margin of the distal part of the radius with volar radiocarpal subluxation (Barton fractures) are well recognized, and substantial data are available to guide their treatment. In contrast, fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation (sometimes referred to as dorsal or reverse Barton fractures) are rarely mentioned, and there are very little data to guide their treatment.

Methods: Twenty patients with a fracture of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation were evaluated. A spectrum of volar injuries was observed: two patients had torn volar ligaments; ten had a displaced, rotated volar marginal lip fracture; six had impaction of the volar aspect of the articular surface; and two had no appreciable volar injury. Fourteen of the twenty patients also had impacted central articular fragments. Eighteen patients underwent surgical reconstruction of the articular surface and application of dorsal buttress plates with use of a variety of surgical approaches. At the time of follow-up, the outcome was assessed radiographically and with use of the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

Results: At an average of thirty months postoperatively, nineteen fractures had healed without substantial loss of alignment and one patient had recurrent dorsal subluxation after plate removal. The final average amount of wrist and forearm motion was 59° of flexion, 56° of extension, 87° of pronation, and 85° of supination. The average grip strength was 85% of that of the contralateral, uninjured hand. The final functional result according to the system of Gartland and Werley was rated as excellent or good for eighteen patients and as fair for two. The average modified Mayo wrist score was 75 points, and the average DASH score was 15 points.

Conclusions: Fractures of the dorsal articular margin of the distal part of the radius with dorsal radiocarpal subluxation are accompanied by a spectrum of volar injuries, including ligament injuries, avulsion fractures, and impaction of the articular surface. Despite the relative complexity of these injuries, satisfactory wrist function can be achieved with operative treatment in most patients.