Functional Outcomes of Volar Barton Fractures Treated with Volar Buttress Plating: A Prospective Observational Study
DOI:
https://doi.org/10.55489/ijmr.14022026103Keywords:
Barton fracture, Distal radius fracture, Volar buttress plate, DASH score, Open reduction internal fixation, Wrist fracture outcomeAbstract
Background: Distal radius fractures constitute 14% of all extremity fractures. Volar Barton fractures, involving the anterior rim of the radiocarpal joint, present a surgical challenge requiring secure internal fixation to restore wrist function. Volar buttress plating has emerged as a preferred technique; however, robust prospective data on functional outcomes using validated scoring systems remain limited in the Indian setting.
Objectives: To evaluate the functional outcomes and postoperative complications of volar Barton fractures treated with open reduction and internal fixation (ORIF) using a volar buttress plate, assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) score.
Methods: This prospective observational study enrolled 101 patients (≥18 years) with volar Barton fractures of the distal radius at a tertiary orthopaedic centre in Indore, India, between August 2022 and January 2024. All patients underwent ORIF via the Modified Henry approach with a volar buttress plate. DASH scores were recorded at 6 weeks, 3 months, and 6 months postoperatively. Radiological parameters including radial length, palmar tilt, radial inclination, and articular step-off were assessed at final follow-up. Statistical analysis employed Wilcoxon signed-rank and paired t-tests; p <0.05 was considered significant.
Results: The study comprised 62 males (61.4%) and 39 females (38.6%), with a mean age of 41.18 ± 13.54 years. Road traffic accidents were the most common mechanism of injury (69.3%). Mean DASH scores improved significantly from 16.87 ± 6.42 at 6 weeks (95% CI: 15.60-18.14) to 13.11 ± 5.85 at 6 months (95% CI: 11.96-14.27) (p <0.001). All patients achieved dorsiflexion >45°, palmar flexion >30°, pronation >50°, and supination >50°. Postoperative complications occurred in 17.8% of patients, predominantly stiffness (15.8%) and malunion (2.0%). A strong negative correlation was identified between palmar tilt and final DASH score (Spearman r = -0.635, p < 0.001), indicating that better palmar tilt restoration predicted superior functional outcomes.
Conclusion: Volar buttress plating for volar Barton fractures yields consistent and sustained functional recovery with a low complication rate. Adequate restoration of palmar tilt is a significant predictor of superior functional outcome.
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Copyright (c) 2026 Sachin Kumar, Rashid Hasan, Varun Chouhan, Lakshya Mahajan, Abdhesh Singh Bhadoria
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