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Die-Punch Fracture
From WikiSM
Contents
Other Names
- Die Punch Fracture
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[1]
Pathophysiology
- Typically occurs as the result of an axial or transverse load through the lunate into the radius
Risk Factors
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
- Dislocations
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Typically swelling, ecchymosis, deformity
- Tenderness to palpation
Evaluation
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
Classification
- N/A
Management
Nonoperative
- Nondisplaced fractures may be managed conservatively
- Splint: Forearm Volar Splint, Short Arm Cast or removable splint
Operative
- Indications
- Open
- Unstable
- Other?
Return to Play
- Nonoperative will require at least 6 weeks
- Surgically managed cases at the discretion of the surgeon
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)
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/