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Die Punch Fracture

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Other Names

  • Die Punch Fracture

Background

  • Fracture of the distal Radius, specifically of the Lunate fossa at the articular surface of the distal radius

History

  • Named after the machining technique of shearing a shape, depression or hole in a material with a die implement or cutter used in the tool-and-die trade[1]
  • First described by Scheck in 1962[2]

Pathophysiology

AP radiograph of the wrist. The die-punch fracture is labeled with a red arrow
  • Typically occurs as the result of an axial or transverse load through the lunate into the radius
  • Known as any depression fracture of the lunate fossa caused by a vertical load through the lunate

Anatomy of the Lunate and Distal Radius

  • Lunate fossa accounts for 46^ of the distal radiocarpal articular surface[3]
  • Lunate facet constitutes the intermediate column of the three-column theory
  • Is the most predominant bearing surface and axial load transfer area of the wrist[4]

Associated Conditions

Risk Factors

Differential Diagnosis

Distal Radius Fractures

Differential Diagnosis Wrist Pain

Clinical Features

  • History
    • Often describe a fall an an outstretched hand
    • Patients will describe pain, swelling of distal radius
    • Deformity
  • Exam: Physical Exam Wrist
    • Ecchymosis, edema
    • Diffuse tenderness to palpation
    • Visible deformity if displaced
    • Range of motion deferred
    • Median, ulnar and radial nerves are typically intact

Evaluation

Die punch fracture status post volar plate fixation

Radiographs

CT scan

  • Used for
    • Evaluate degree of comminution
    • Surgical planning

MRI

  • Evaluate for concomitant soft tissue injuries

Classification

  • Needs to be updated

Management

Nonoperative

  • Indications
    • Extra-articular
    • < 5 mm radial shortening
    • Dorsal angulation < 5°, within 20° of contralateral radius
  • Splint: Forearm Volar Splint, Short Arm Cast or removable splint

Operative

  • Indications: Most
    • Open
    • Unstable
    • Other?
  • Technique
    • Open reduction, volar plate fixation[5]
    • CRPP (closed reduction, percutaneous pinning)

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Nonoperative will require at least 6 weeks
  • Surgically managed cases at the discretion of the surgeon

Prognosis and Complications

Prognosis

  • Needs to be updated

Complications

See Also

Internal

External

References

  1. ↑ https://radiopaedia.org/articles/die-punch-fracture?lang=us
  2. ↑ Scheck M. Long-term follow-up of treatment of comminuted fractures of the distal end of the radius by transfixation with Kirschner wires and cast. J Bone Joint Surg Am, 1962, 44-A: 337–351.
  3. ↑ Mekhail AO, Ebraheim NA, McCreath WA, Jackson WT, Yeasting RA. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surg Am, 1996, 21: 567–573.
  4. ↑ Rainbow MJ, Kamal RN, Evan L, et al. In vivo kinematics of the scaphoid, lunate, capitate, and third metacarpal in extreme wrist flexion and extension. J Hand Surg Am, 2013, 38: 278–288.
  5. ↑ Zhang X, Zhao Y, Hu C, et al. Comparative study of type B distal radius fractures with and without lunate facet involvement treated by volar locking plate, an observational study. Int J Surg, 2017, 44: 317–323.
Created by:
John Kiel on 4 July 2019 07:02:10
Authors:
Last edited:
15 September 2023 14:36:24
Categories:
Trauma | Osteology | Wrist | Forearm | Upper Extremity | Fractures | Acute

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