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Radiographic Characteristics of Volar Barton Distal Radius Fractures
Michael C Daly, MD MSc; Chaitanya Mudgal, MD; Taylor A. Horst, MD; Lydia A. Helliwell, MD
Massachusetts General Hospital, Boston, MA
Introduction: This study analyzes fracture geometry on pre-operative CT scans of volar Barton distal radius fractures to determine the frequency of a dorsal cortical break (fracture line extending through the distal radial dorsal metaphyseal cortex), and to test the null hypothesis that the presence of a dorsal cortical break is not associated with age or gender.
Materials & Methods: We reviewed the records of adults with a volar Barton distal radius fracture (OTA 23-B3 or OTA 23 type C) treated by a single surgeon between 2007 and 2015. Surgically treated patients (CPT codes 25608 or 25609) with pre-operative CT scans were included. We analyzed CT scans and recorded variables listed in Table 1 and illustrated in Figure 1A–E. Our main outcome measure was the presence of a dorsal cortical break; our main predictor was age. We analyzed baseline variables using nonparametric bivariate statistics.
Results: We identified 26 patients (mean age 49 years, 69% female). All were treated with pre-contoured volar plates. The main fracture line of the volar piece starts within the radiocarpal joint, involving an average of 44.2% of the scaphoid fossa and 49.5% of the lunate fossa. This fracture line extends proximally, exiting an average of 20.7mm from the volar articular margin of the distal radius for the main volar fragment (Table 1, Figure 1A–C). The majority of patients had 3 or more discrete fracture fragments (77%), central articular depression (69%), and a dorsal cortical break (73%) (Table 1, Figure 1D–E). Comparing those with and without a dorsal cortical break, there was no difference in age (51+/-20 versus 42+/-20 years, OR 1.02 [95% CI: 0.98-1.07], P=0.29, Wilcoxon rank sum test) or gender (68% versus 57% female, OR 0.61 [95% CI: 0.07-5.67], P=0.66, Fisher's exact test).
Conclusion: Most (73%) patients with surgically treated volar Barton distal radius fractures had a dorsal cortical break, which occurred an average of 10.5mm from the dorsal articular rim of the distal radius. The presence of a dorsal cortical break was not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously postulated by Harness et al in 2004.
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