DISTAL RADIUS [CASE 03] - Volar Barton

This orthopedic trauma learning case presents the operative reasoning for fixation of a distal radius articular fracture with a volar Barton pattern. The video focuses on procedural anatomy of the wrist, use of fluoroscopy for incision planning and intraoperative assessment, and a volar Henry approach through the interval between the radial artery and flexor carpi radialis. The case highlights layered dissection, identification of the flexor carpi radialis, flexor pollicis longus, and pronator quadratus, followed by an L-shaped pronator quadratus elevation to expose the distal radius fracture. The educational emphasis is on understanding the fracture mechanics, including a volar articular fragment, carpal subluxation tendency, and a near-intact cortical hinge. The procedure demonstrates reduction using the plate and a proximal cortical screw to help correct the exaggerated volar angulation while minimizing additional manipulation of the fracture line. Distal screw distribution, including fixation toward the radial styloid fragment, is reviewed under fluoroscopic control, with attention to confirming that screws are not intra-articular. The case concludes with attempted pronator quadratus approximation when feasible and standard layered closure. This content is intended for structured surgical education and should be reviewed by qualified medical professionals before application in practice.

INCLUDED CONTENT

• Case-based surgical walkthrough of a volar Barton distal radius fracture.
• Volar Henry approach anatomy and dissection sequence.
• Fluoroscopic localization and intraoperative imaging checkpoints.
• Pronator quadratus exposure and elevation technique.
• Plate-assisted fracture reduction rationale.
• Distal radius plate and screw positioning strategy.
• Radiographic confirmation of articular alignment and screw position.
• Soft-tissue closure considerations.

TARGET AUDIENCE

• Orthopedic trauma surgeons
• Orthopedic surgery residents and fellows
• Hand and wrist surgery trainees
• Medical educators in musculoskeletal trauma
• Operating room professionals involved in orthopedic trauma education

EDUCATIONAL NOTICE

This material is intended for medical and surgical education only. It does not replace formal training, institutional protocols, clinical judgment, or supervision by qualified professionals. No clinical outcome is promised or implied. Human expert review is required before using any procedural concept in patient care.