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Die Punch Fracture
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(Redirected from Die-Punch Fracture)
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
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
- 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
- DRUJ Injury
- Radial Styloid Fracture
- Soft tissue injuries
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
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
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
Radiographs
- Standard Radiographs Wrist
- Findings can be subtle
- May be proximal displacement of lunate and interruption of carpal arc
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
- 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/
References
- ↑ https://radiopaedia.org/articles/die-punch-fracture?lang=us
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.