Die-Punch Fracture

Other Names

• Die Punch Fracture

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Background

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

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Pathophysiology

• Typically occurs as the result of an axial or transverse load through the lunate into the radius

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Risk Factors

• Osteoporosis

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Differential Diagnosis

Distal Radius Fractures

• Barton's Fracture
• Chauffer's Fracture
• Colles' Fracture
• Die-Punch Fracture
• Radial Styloid Fracture
• Smith's Fracture

Differential Diagnosis Wrist Pain

• Fractures
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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Clinical Features

• General: Physical Exam Wrist
• Typically swelling, ecchymosis, deformity
• Tenderness to palpation

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Evaluation

AP Radiogrpah of wrist showing distal radius fracture consistent with die punch fracture and ulna styloid fracture

Radiographs

• Standard Radiographs Wrist
• Findings can be subtle
• May be proximal displacement of lunate and interruption of carpal arc

CT scan

• Important to evaluate intra-articular component

MRI

• Evaluate for soft tissue injuries

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Classification

• N/A

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Management

Nonoperative

• Nondisplaced fractures may be managed conservatively
• Splint: Forearm Volar Splint, Short Arm Cast or removable splint

Operative

• Indications
  • Open
  • Unstable
  • Other?

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Return to Play

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

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Complications

• Median Nerve Neuropathy
• Ulnar Nerve Neuropathy
• EPL Rupture
• FPL Rupture
• Radiocarpal Arthropathy
• Malunion or Nonunion
• ECU or EDM Entrapment
• Acute Compartment Syndrome
• RSD/ CRPS
• Distal Radioulnar Joint Disruption
• TFCC Injury
• Scapholunate Instability (DISI)
• Lunotriquetral Instability (VISI)

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist
• External
  • Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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