Functional outcomes following volar locking plate fixation of AO/OTA 23-B3 volar Barton fractures: a prospective cohort study

Background: Volar Barton fractures are unstable intra-articular fractures of the distal radius characterized by disruption of the volar rim and radiocarpal instability. Anatomical reduction and stable fixation are important to restore joint congruity, permit rehabilitation, and reduce the risk of persistent instability and post-traumatic dysfunction. Volar locking plate fixation provides angular stability and subchondral support and is widely used for unstable distal radius fracture patterns. Methods: A prospective cohort study was conducted at a tertiary care teaching hospital between April 2024 and October 2025. Thirty adult patients with closed AO/OTA 23-B3 volar Barton fractures underwent open reduction and internal fixation using a volar locking plate through the modified Henry approach. Patients were followed for 12 months. Functional outcome was assessed using the Modified Mayo Wrist Score (MMWS), which evaluates pain, functional status, range of motion, and grip strength. Clinical and radiological union, postoperative complications, and serial functional recovery were recorded at predefined follow-up intervals. Results: Thirty patients completed the study. The mean age was 41.6±13.4 years and 23 patients (76.7%) were male. Radiological union was achieved in all patients without loss of reduction or implant failure. At 12 months, 20 patients (66.7%) had excellent MMWS outcomes, 7 (23.3%) had good outcomes, and 3 (10.0%) had fair outcomes; therefore, 90.0% achieved good-to-excellent functional results. Three patients (10.0%) developed superficial wound infection, all of which resolved with antibiotic therapy and local wound care. Conclusions: Volar locking plate fixation was associated with reliable fracture union and progressive improvement in pain, wrist motion, grip strength, and patient satisfaction during the first postoperative year. The findings support volar locking plate fixation as an effective treatment option for unstable AO/OTA 23-B3 volar Barton fractures, while the absence of a comparison group limits conclusions regarding superiority over alternative treatments.