■Barton骨折是指延伸穿过关节面背侧的桡骨远端骨折,伴有桡骨关节脱位。它们非常不稳定,需要切开复位和内固定(ORIF)。延迟演示通常很难实现减少,可能需要更广泛的手术。这里,我们介绍了一例3周大的右侧腕部Barton骨折,在农村地区采用常规方法治疗。
■一位32岁的绅士最初被拒绝接受手术干预,原因是他在机动车事故后遭受的桡骨远端骨折,并在门诊部接受长臂板和镇痛药治疗,并同意在保守治疗后病情没有改善后进行手术干预。在臂丛神经阻滞下,采用trans-FCR(radial腕屈肌)方法进行手术。通过向桡骨远端施加压力来减少碎片,并通过成像确认。使用K线(Kirschner)暂时保持碎片。使用掌侧桡骨远端锁定板支撑远端碎片。使用总共六个螺钉进行最终固定。将手腕夹板固定在短的背片中。2周后取皮肤缝线,术后6周后开始主动辅助腕关节的活动范围。
■掌侧Barton是一种罕见的关节内骨折,通常是由高速损伤造成的。被忽视骨折的普遍共识是,不处理或处理不当导致治疗延迟的骨折,骨折恶化,甚至残疾被认为是被忽视的骨折。正确重建受损的解剖结构,手功能的无问题恢复是治疗的主要目标。由于保守疗法通常无效且副作用盛行,包括早期骨关节炎,畸形,半脱位,和不稳定性,手术稳定和解剖复位是治疗这些骨折的关键.铺板是文献中描述的各种治疗方式中的治疗方式之一,其能够通过直接解剖修复和稳定的内固定来实现腕部功能的更短时间的固定和早期恢复。在我们的案例中,愈伤组织相对不成熟,并且可以很容易地清除原始骨折部位。此外,没有明显的软组织缩短,掌侧碎片没有向近端迁移,与长期被忽视的情况相反。因此,术中复位是可能的,骨折像往常一样用掌侧锁定钢板固定。
■考虑到适度的组织缩短和年轻的愈伤组织,此类病例可作为常规Barton骨折治疗,并采用常规锁定支撑钢板固定方法进行治疗。然而,通过携带K线和手腕分散注意力来为潜在的故障做好准备是有意义的。为了恢复受伤手腕的完整功能,充分的物理治疗和术后夹板固定是术后康复的重要组成部分。
UNASSIGNED: Barton fractures are distal radius fractures that extend through the dorsal aspect of the articular surface, with associated dislocation of the radiocarpal joint. They are extremely unstable and require open reduction and internal fixation (ORIF). Delayed presentation is often encountered with difficulty in achieving reduction, and more extensive surgery may be needed. Here, we present a case of a 3-week-old
neglected volar Barton fracture of the right wrist treated with the conventional method in a rural setting.
UNASSIGNED: A 32-year-old gentleman was initially denied surgical intervention for a distal radius fracture he sustained after a motor vehicle accident and was discharged with a long arm slab plus analgesics represented in the outpatient department and agreed upon surgical intervention after his condition did not improve with conservative treatment. The trans-FCR (flexor carpi radialis) approach was used for surgery under the brachial plexus block. The fragment was reduced by applying pressure volarly into the distal radius and was confirmed with imaging. A K-wire (Kirschner) was used to temporarily hold the fragment. A volar distal radius locking plate was used to buttress the distal fragment. Final fixation was made using altogether six screws. The wrist was splinted in a short dorsal slab. Skin sutures were removed after 2 weeks, and an active assisted range of motion of the wrist was begun after 6 postoperative weeks.
UNASSIGNED: Volar Barton is an uncommon subset of intra-articular fractures and typically results from damage sustained at high speeds. The general agreement for
neglected fractures is that \'fractures that are not handled or mishandled resulting in treatment delay, worsening of the fracture and even a disability\' are to be considered
neglected fractures. Rebuilding the damaged anatomy properly and enabling a prompt, problem-free recovery of hand function are the main objectives of treatment. As conservative therapy is often ineffective and rife with side effects, including early osteoarthrosis, deformity, subluxation, and instability, stabilization and anatomic reduction by surgery is the key to managing these fractures. Plating is one of the therapeutic modalities among various therapeutic modalities depicted in the literature that enables shorter time of immobilization and early restoration of wrist function through direct anatomic repair and stable internal fixation. In our case, the callus was relatively immature, and the original fracture site could easily be cleared. Also, there was no significant soft tissue shortening, and the volar fragment had not migrated proximally, in contrast to what is expected in prolonged
neglected cases. Hence, the intraoperative reduction was possible, and the fracture was fixed with a volar locking plate as usual.
UNASSIGNED: Given the modest tissue shortening and young callus, such cases may be treated as conventional Barton\'s fractures and managed using conventional means of fixation with locking buttress plates. However, it makes sense to prepare for potential malreduction by carrying K wires and wrist distractions. To restore complete function to the injured wrist, adequate physiotherapy and postoperative splinting are essential components of postoperative rehabilitation.