From the Guidelines
Barton and Smith fractures are distinct types of distal radius fractures with different fracture patterns and mechanisms, requiring tailored treatment approaches to optimize outcomes. The primary difference between the two lies in their fracture characteristics and associated joint dislocation. A Barton fracture is a fracture-dislocation involving the dorsal or volar rim of the distal radius, with the fracture fragment including the articular surface and carpal displacement in the same direction as the fragment 1. In contrast, a Smith fracture is a transverse fracture of the distal radius with volar displacement of the distal fragment, often resulting from a fall onto a flexed wrist or direct force to the dorsum of the wrist. Key differences in mechanisms include:
- Axial loading on a flexed wrist with pronation (volar Barton) or supination (dorsal Barton) for Barton fractures
- Fall onto a flexed wrist or direct force to the dorsum of the wrist for Smith fractures Treatment for both typically involves surgical fixation with plates and screws to restore articular congruity and prevent post-traumatic arthritis, with specific approaches varying based on fracture characteristics, displacement, and patient factors 1. Early orthopedic consultation is crucial for optimal management of these unstable fractures. Considerations for treatment include:
- Fracture pattern and extent of injury
- Patient age and activity level
- Presence of associated injuries or comorbidities
- Need for prompt restoration of wrist function and prevention of long-term disability.
From the Research
Difference between Barton and Smith Wrist Fractures
- The main difference between Barton and Smith wrist fractures lies in their characteristics and treatment approaches, as discussed in various studies 2, 3.
- A Barton fracture is a type of distal radius fracture, which can be treated with closed reduction and percutaneous pinning (CRPP) in select cases, as shown in a study on distal radius fractures 4.
- Smith's fracture, on the other hand, is also a type of distal radius fracture, but with different radiographic characteristics and management options, as reviewed in an evidence-based review of distal radius fractures 5.
- The original descriptions of Barton and Smith fractures, as well as their current management, have been discussed in the literature, providing insight into the differences between these two types of fractures 2, 3.
- It is essential to understand the specific characteristics and treatment options for each type of fracture to provide effective management and restore radiographic parameters and functional outcomes, as highlighted in a study on CRPP for distal radius fractures 4.