Question
A 41 year old cyclist falls onto a flexed wrist. He has a deformed, painful wrist with tingling in the thumb and index finger.
- Describe the injury.
- What are the treatment principles?
- How would you manage his symptoms in the median nerve distribution?
Answer
Injury
- Volar shear fracture of the distal radius with volar subluxation of the carpus
- Volar Barton fracture, a partial articular AO 23 B3 injury
- Unstable pattern, cannot be held in a cast
Treatment principles
- CT to define fragments, including the volar lunate facet
- Volar buttress plate through a flexor carpi radialis (modified Henry) approach
- Distal plate placement below the watershed line only if needed to hold the volar ulnar fragment
- Small volar lunate facet fragments may need a hook plate or wire
- Restore volar tilt, radial height and articular congruity, step under 2 mm
- Check DRUJ stability after fixation
Median nerve symptoms
- Distinguish contusion from acute carpal tunnel syndrome
- Progressive or worsening symptoms after reduction, urgent carpal tunnel release with fixation
- Static mild symptoms that improve after reduction can be observed
- Avoid casting in wrist flexion (Cotton-Loder position)
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.