Barton's Fracture: Causes, Signs, Treatment, PT, Exercises, Investigations
What is Barton's Fracture?
Barton's Fracture is a type of distal radius fracture that occurs near the base of the thumb. Barton's fracture is a fracture that occurs when there is an injury at the base of the thumb. Occasionally some degree of carpal displacement is also involved and this condition is termed as a fracture dislocation.
High potential sports where there is a risk of impact with the ground or collision with another player such as football, soccer, skiing and snowboarding could cause Barton's fracture. Generally, stress is placed on the radius during a fall on the outstretched hand. When the impact is high and the stress beyond the withstanding capacity of the bone, it may result in breaking of the radius. Due to frail and weak bones and tendency to fall due to weakness, radius fracture is more commonly seen in the elderly.
Barton's fracture can occur on either of the two aspects that is dorsal or the back side of the wrist or volar side or palmar side of the wrist, the volar side being most common.
Causes of Barton's Fracture
- Landing on the outstretched hand with palm facing downwards.
- Falling down from a height.
- Falling down in sports such as football, baseball and soccer.
- Snowboarding accident.
- Car accident.
- Bike accident.
- Skiing accident.
Signs and Symptoms of Barton's Fracture
- Acute pain after an impact or fall.
- Development of swelling.
- Feeling difficulty while performing movements of the wrist.
- Appearance of deformity in the wrist.
- Pain is felt during movements of the wrist.
- Appearance of bruising.
Treatment for Barton's Fracture
In a few cases, there is just displacement or a sort of deviation of bone from its natural alignment. This may hamper the use of arm or wrist. Such deformities may be rectified with manipulation as well as reduction. Conservative measures involve closed reduction under local anesthesia and then casting or splinting of hand and thumb. Fracture may take about 10 weeks to fully heal, which also includes a period of immobilization for about six weeks followed by splinting for about six weeks.
Surgical Treatment: For a vast majority of cases, surgery is required for treatment of this fracture as the bone gets deformed to such a degree that it is not able to be corrected with closed reduction. This procedure of correcting and realigning the bone to its normal position is called open reduction.
Surgery involves creating an incision to expose the fracture and restore it to its usual position. Sometimes, hardware is utilized for this purpose like metal pins, plates, screws and at times an external fixator is also used.
The surgical procedure carries a risk of infection, bleeding, damage to neurovascular structures, and failure of hardware.
Physical Therapy for Barton's Fracture
Physical therapy is necessary for all patients to hasten healing and restore normal functionality of the wrist and hand.
Physical Therapy May Include
- Joint mobilization.
- Soft tissue massages.
- Use of ice or heat.
- Exercises for improving strength and flexibility.
- Activity modification and retraining.
- Gradual return to activity.
Exercises for Barton's Fracture
- Elbow Bend to Straighten: This is done by bending and straightening the elbow as far as possible until pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Wrist Bends: This exercise is performed by placing the forearm on a table and the wrist and fingers over the edge. Bend the wrist forwards and backwards slowly until a mild to moderate pain-free stretch is sensed. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Forearm Rotations: This is done with the elbow at the side and bent to 90 degrees. Rotate the palm up and down slowly as far as possible until a mild to moderate pain-free stretch is sensed. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Wrist Side Bends: This is done by placing the forearm on the table and the wrist and fingers over the edge. The wrist is then bent from side to side slowly as far as possible until a mild to moderate pain-free stretch is sensed. Repeat 10 times making sure there is no aggravation of symptoms.
Investigations for Barton's Fracture
- X-ray of the wrist.
- CT scan in rare cases.
- MRI in rare cases.