Surgical treatment of die-punch fracture of the distal radius

Abstract

Objective To explore the treatment outcomes of surgical management of die-punch fractures of the distal radius.Methods Fifteen cases of die-punch fractures of distal radius with displacement and unsatisfactory reduction were operated between January 2005 and December 2011.The fractures were confirmed by Ⅹ-ray and CT scans.There were 4 cases of dorsal fractures,1 case of volar fracture,2 cases of split fractures,5 cases of fracture collapse and 3 cases of split fractures associated with collapse.Of the 15 cases,3 cases were accompanied with distal radio-ulnar joint dissociation and 3 cases accompanied by ulnar styloid fracture.Volar surgical approach was taken for all the types except the dorsal fractures which were treated via dorsal approach.In this group,2.4 mm or 2.7 mm anatomical titanium plate was used in 6 cases,3.5 mm plate in 3 cases,screws in 3 cases,Kirschner wires in 1 case and Kirschner wires combined with external fixator in 2 cases.Of the 3 cases accompanied by distal radio-ulnar joint dissociation,one was still unstable after reduction and was fixed with Kirschner wire for 5 weeks.The other two had bone grafting.Results Primary healing of incisions was achieved in all the patients.There were no injuries to the nerves and vessels,no loosening or breakage of the implants and no fracture nonunion.All 15 cases were follow-up for 9 to 28 months with an average of 13 months.Mild traumatic arthritis of the wrist was seen in 1 case that had unsatisfactory fracture reduction.Wrist function was assessed according to Sarmiento scale and was rated as excellent in 9 cases,good in 5 cases and fair in 1 case,with an excellent and good rate of 93.3％.Conclsion Die-punch fracture of the distal radius is a special intra-articular fracture.Early surgical management should be conducted for cases with fracture displacement and unsatisfactory fracture reduction to obtain good results. Key words: Fractures, bone; Fracture fixation; Distal radius