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Abstract: This 35-year-old young male fell down accidentally while doing housework and injured the right distal radius, which caused significant pain in the right wrist, immobility and deformity in appearance, during which he did not apply ice by himself. The fracture was repositioned satisfactorily after 2 times of manipulation, and was fixed with external plaster brace, and was reviewed every half month.
Basic information】Male, 35 years old
Disease Type】Barton fracture
Hospital】Shanxi Provincial People’s Hospital
Date of consultation】May 2021
Treatment plan】Manipulation + medication (Mizarin tablets)
Treatment Period】5 days of inpatient treatment, half-monthly outpatient follow-up
Treatment effect] Satisfactory fracture reduction
I. Initial consultation
A patient came to the clinic with his left hand holding his right hand, the swelling of his right hand was obvious, and there were blood stains on it that had crusted over. The patient came with his own frontal and lateral X-rays of the distal right radius, and on the films, he was able to clearly see a partial intra-articular fracture of the dorsal margin of the distal right radius with dorsal dislocation of the wrist joint. The patient could be clearly diagnosed with a right Barton fracture (Barton fracture).
II. Treatment history
Upon admission, the patient’s right hand was first treated for blood scabs on top of the right hand and checked to see if the bleeding was from a superficial injury or an open fracture. If it was only a superficial injury it could be repositioned by manipulation; if it was an open fracture, emergency surgery was required for wound debridement. After wiping the blood crust, see that it is only bleeding from a superficial injury. We planned to perform a manipulation reset and communicated with the patient before the reset: the manipulation reset often could not achieve the expected effect at one time, and the X-rays needed to be reviewed after each reset and then reset according to the latest X-rays for at least 2-3 times to achieve the expected effect, or the effect might not be satisfactory even after multiple resets, and then surgery would need to be considered. The patient agreed and was willing to try the manual repositioning. The patient was then repositioned for the first time, and immediately after the repositioning, the patient was externally fixed with a brace, and the right distal radius was reviewed on positive and lateral radiographs. The following day, with reference to the film after the 1st repositioning, the 2nd repositioning was performed, and the X-ray was reviewed, and the fracture was satisfactorily repositioned, and external fixation in plaster was given to avoid displacement of the fracture.
III. Treatment effect
After the 2nd repositioning, the X-rays of the right distal radius were reviewed, and part of the intra-articular fracture block of the dorsal margin of the right distal radius was repositioned and aligned neatly with the normal bone block on the palmar side, and the dorsal dislocation of the wrist joint was also significantly corrected, and the wrist joint gap was even. The patient was additionally instructed to apply ice and to take oral Mizarin tablets. On the fourth day, the patient reported that the pain and swelling were significantly reduced, and the right finger could be flexed and extended appropriately under the cast immobilization. The patient was discharged from the hospital after 5 days of hospitalization and was asked to review the patient’s condition every half month.
IV. Notes
We are glad to recover the fracture by repositioning, because the maintenance of the fracture position after repositioning relies on the surrounding muscles and soft tissues, unlike the stability of surgical plate and screw, so even if the fracture is satisfactorily repositioned at that time, the fracture is prone to re-dislocation later. In order to ensure that the fracture is not easily re-dislocated after reset, external fixation in plaster is required after reset. If the plaster is too tight, the osteo-fascial compartment syndrome caused by external fixation may easily occur, so the patient should be advised to pay more attention to the end blood flow and sensation of the affected hand, whether there is pallor, numbness at the end of the fingers, or pain at the end of the fingers, and if there are such symptoms, the plaster should be released in time.
In addition, cast fixation is prone to pressure sores, so if the patient feels pain and itching of the skin inside the cast, he/she should come to the hospital to release the cast in time. If the fracture is displaced, it should be reset again in time.
V. Personal insight
Barton fracture is a kind of distal radius fracture, which is common in the clinic. For Barton fracture, the treatment plan is different according to the severity of its injury, and not all Barton fractures can be repositioned by manipulation. For fractures that are not significantly displaced or can be stably maintained in position after repositioning, conservative treatment (i.e., non-operative treatment with external fixation in a cast) can be performed. However, for fractures that are difficult to reset, or even if they are reset, the fracture is immediately dislocated and cannot be maintained in position, surgical treatment is required. Usually, for less severe cases like this patient, the condition can be effectively relieved with conservative treatment.