Distal radius die-punch fracture

Case contributed by Dr Paul Heyworth

Presentation

4 weeks post fall. Painful wrist

Patient Data

Age: 70
Gender: Female
X-ray

There is a transverse fracture of the distal radius which is in near anatomical alignment, with early bony healing. In addition there is a die-punch fracture with mild depression of the lunate fossa of the radial articular surface and fracture lines extending to the base of the radial styloid and ulnar aspect of the transverse fracture line. Mild resulting depression of the lunate. Scapholunate interval within normal limits.

Mild STT articulation degeneration. No other fractures. No soft tissue swelling.

Case Discussion

A die-punch fracture results from axial loading forces on the distal radius. It is an intra-articular fracture of the lunate fossa of the distal radius 1. It is by definition depressed or impacted and is named after the machining technique of shearing a shape, depression or hole in a material with a die implement or cutter. The die-punch mechanism classically involves the lunate fossa of the radius but can occur from any loading injury 2.

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