Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 12;14(2):127-131.
doi: 10.1055/s-0040-1712328. eCollection 2022 Apr.

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

Sezai Özkan  1   2 , Svenna H W L Verhiel  1 , Samantha A Jayasinghe  3 , Chaitanya S Mudgal  1
Affiliations

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

Sezai Özkan et al. J Hand Microsurg. .

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: die punch; distal radius fractures; dorsal-ulnar corner.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared. Authors’ Contributions This study represents a great deal of effort, resources, and dedication on the part of the authors in reviewing and reconstructing all cases, reviewing the literature and performing statistical analyses. All authors have participated in a material way to the elements below: Study design: S.Ö., S.V., S.J., C.M. Gathered data: S.Ö., S.V., S.J. Analyzed data: S.Ö., C.M. Initial draft: S.Ö., S.V., C.M. Ensured accuracy of data: S.Ö., S.V., S.J. Note This work was performed at the Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States. Ethical Approval The Institutional Review Board approved this study under protocol MGH/2009P001019.

Figures

Fig. 1
Fig. 1
The most distal axial slice of the CT scan that showed the articular surface of the DRUJ. B and C represent the borders of the die punch fragment, whereas A is the length of the DRUJ without the length of the die punch fragment. The proportion of the die punch fragment relative to that of the DRUJ was calculated by dividing B by A + B. CT, computed tomography.
Fig. 2
Fig. 2
In clinical (intraoperative) settings, the borders of the die punch fragment can be defined by assessing whether it moves as a unit, whereas in a research setting, it is difficult to define which line to select to define the borders of the die punch fragment.
See this image and copyright information in PMC

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. - PubMed
    1. Fernandez D L, Geissler W B. Treatment of displaced articular fractures of the radius. J Hand Surg Am. 1991;16(03):375–384. - PubMed
    1. Mekhail A O, Ebraheim N A, McCreath W A, Jackson W T, Yeasting R A. Anatomic and X-ray film studies of the distal articular surface of the radius. J Hand Surg Am. 1996;21(04):567–573. - PubMed
    1. Falcochio D F, Crepaldi B E, Trindade C A, da Costa A C, 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. - PMC - PubMed
    1. Cole R J, Bindra R R, Evanoff B A, Gilula L A, Yamaguchi K, Gelberman R H. 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. - PubMed

LinkOut - more resources