A 68-year-old female presented after falling and injuring her left wrist while getting out of the shower. On examination, she had obvious swelling and deformity of the right wrist with limited range of motion. X-rays revealed a distal radius fracture with dislocation of the radiocarpal joint, known as a dorsal Barton's fracture. Treatment would involve pain control, closed reduction of the fracture under sedation, and orthopedic consultation as non-operative treatment often fails for this type of injury.

2.  68 yo female presents after  T 97.6 P 98 BP 159/86 O2
slipping and falling while 97%
getting out of the shower.  Gen: In obvious pain but
Pt fell forward onto her NAD
outstretched hand, with  MSK- obvious dorsal
her wrist extended. Pt deformity/swelling to right
complains of extreme pain
wrist, limited range of
in her left wrist, and denies motion in right wrist, 1+
hitting her head or any radial pulse
other injuries.
 Neuro- limited
flexion/extension right
wrist, nl sensation
throughout

4. Distal radius fracture w/ dislocation of radiocarpal joint

5.  Pain Control
 Reduction of fracture, usually under conscious
sedation
 Ortho consult needed, as non-op treatment usually
fails
 Stability of reduction of dorsal Barton fx is best
obtained with wrist extension to take advantage of
intact volar carpal ligament

6.  Most common fx dislocation of the wrist joint;
- comminuted fx of distal radius may involve
either anterior or posterior cortex and
may extend into the wrist joint
 Fx dislocation or subluxation in which the rim of distal
radius (dorsally or volarly) is displaced with the hand and
carpus;
- it often occurs along with a radial styloid frx
- it differs from Colles' or Smith's Fracture in that the
dislocation is the most striking radiographic finding
 More common for distal fragment to be displaced dorsally,
although it can dislplace volarly also (volar Barton’s fx)

8.  http://www.wheelessonline.com/ortho/dorsal_barton
s_fracture_dorsal_shearing_frx
 http://www.freebase.com/view/en/distal_radius_fract
ure
 http://myradnotes.wordpress.com/2008/06/
 http://www.radiologyassistant.nl/en/476a23436683b