Vol. 6, Issue 1, Part A (2024)

Background: Barton’s fracture is uncommon intra-articular fractures of distal end of the radius. They are usually associated with high-velocity trauma. Internal fixation using monoaxial or poly-axial locking screws with a minimal invasive technique (pronator quadratus muscle sparing) gives a great benefit for the patients, allowing them to restore movement of their wrist almost immediately after surgery and quick regain their autonomy.

Methods: This study include 20 patients; the youngest patient was 26 years of age at the time of surgery and the eldest was 60 years of age with a mean of 35.45 years. The group of patients involved 15 males (75%) and 5 females (25%).12 patients (60%) had left hand distal radius fractures, while 8 patients (40%) hand right hand distal radius fracture and right hand was dominant in all patients. Fall on outstretched hand is found to be the most common mode of trauma producing the fracture in eight patients (40%), while other causes represent less percentage.

Results: Pronator quadratus muscle found ruptured from initial injury in 3 patients, the percentage of failed pronator quadratus preserving technique was about 25.9%. The mean time was 3.42 days. The mean of operative time after induction of anesthesia for doing surgery was 95 min. There was minimal intra operative blood loss during surgery. Mean follow up was 7.15 months. Final clinical judgment was based on Mayo score for range of motion, hand grip strength, wrist pain and wrist function, considering patient satisfaction. The mean percentage of hand grip strength reached about 85.5% of normal side by the end of the sixth month follow up. In mayo score improved form moderate to minimal or even painless with significant difference. Pain is less in cases operated with pronator quadratus preserving technique comparing with others failed to preserve pronator quadratus muscle. Wrist score improved all over the period of follow up. Only 2 cases complicated in this study with post-operative hematoma, and single case complicated with superficial infection which is completely resolved within 2 weeks on antibiotic course.

Conclusion: Sparing of pronator quadratus muscle technique is ideal for volar shear fractures of distal radius. Using low profile locked plates and screws system allows easy sliding beneath the pronator quadratus muscle compared to other types of plates.