The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation

Abstract

Introduction Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment.

Materials and Methods We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures.

Results Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach.

Conclusion DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation.

Level of Evidence This is a Level IV,—retrospective study.

Keywords

distal radius fractures - die punch - dorsal-ulnar corner

Publikationsverlauf

Artikel online veröffentlicht:
12. Mai 2020

• References

• 1 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
• 2 Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. J Hand Surg Am 1991; 16 (03) 375-384
• 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 (04) 567-573
• 4 Falcochio DF, Crepaldi BE, Trindade CA, da Costa AC, Chakkour I. What is the best radiographic view for “die punch” distal radius fractures? A cadaver model study. Rev Bras Ortop 2015; 47 (01) 27-30
• 5 Cole RJ, Bindra RR, Evanoff BA, Gilula LA, Yamaguchi K, Gelberman RH. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg Am 1997; 22 (05) 792-800
• 6 Baratz ME, Des Jardins Jd, Anderson DD, Imbriglia JE. Displaced intra-articular fractures of the distal radius: the effect of fracture displacement on contact stresses in a cadaver model. J Hand Surg Am 1996; 21 (02) 183-188
• 7 Melone Jr CP. Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am 1993; 24 (02) 239-253
• 8 Freeland AE, Geissler WB. The arthroscopic management of intra-articular distal radius fractures. Hand Surg 2000; 5 (02) 93-102
• 9 Earp BE, Foster B, Blazar PE. The use of a single volar locking plate for AO C3-type distal radius fractures. Hand (N Y) 2015; 10 (04) 649-653
• 10 Trumble TE, Culp RW, Hanel DP, Geissler WB, Berger RA. Intra-articular fractures of the distal aspect of the radius. Instr Course Lect 1999; 48: 465-480
• 11 Lutsky K, Boyer M, Goldfarb C. Dorsal locked plate fixation of distal radius fractures. J Hand Surg Am 2013; 38 (07) 1414-1422
• 12 Tavakolian JD, Jupiter JB. Dorsal plating for distal radius fractures. Hand Clin 2005; 21 (03) 341-346
• 13 Rhee PC, Medoff RJ, Shin AY. Complex distal radius fractures: an anatomic algorithm for surgical management. J Am Acad Orthop Surg 2017; 25 (02) 77-88
• 14 Abe Y, Tokunaga S, Moriya T. Management of intra-articular distal radius fractures: volar or dorsal locking plate-which has fewer complications?. Hand (N Y) 2017; 12 (06) 561-567
• 15 Ruch DS, Papadonikolakis A. Volar versus dorsal plating in the management of intra-articular distal radius fractures. J Hand Surg Am 2006; 31 (01) 9-16
• 16 Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am 2006; 88 (09) 1944-1951
• 17 Rozental TD, Blazar PE. Functional outcome and complications after volar plating for dorsally displaced, unstable fractures of the distal radius. J Hand Surg Am 2006; 31 (03) 359-365
• 18 Zhang X, Hu C, Yu K. et al Volar locking plate (VLP) versus non-locking plate (NLP) in the treatment of die-punch fractures of the distal radius, an observational study. Int J Surg 2016; 34: 142-147
• 19 Hamada Y, Gotani H, Hibino N. et al Surgical strategy and techniques for low-profile dorsal plating in treating dorsally displaced unstable distal radius fractures. J Wrist Surg 2017; 6 (02) 163-169
• 20 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
• 21 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861