Treatment of Die-punch fractures in Unstable Distal Radius Fractures

Rhee, Seung koo; Song, Seok Whan; Chung, Yang Guk; Lee, Wha Seong; Ryoo, Seung Joon

Abstract

Die-punch fracture is a comminuted intra-drticular fracture on the distal radius with depressed articular fragments caused by impaction of carpal bones, mainly lunate or scaphoid. As in the other intra-articular fractures, the accurate rehtoration of congruent articular surface is necessary to get good functional results. The purpose of this study is to review the results in a series of 24 die-punch fracturef according to the type of fractures dnd the method of treatments. During the 5 year period after July, 1993, total 24 die-punch fractures in 22 patients were treated by surgery(22 cases) or closed method(2 cases) and were followed up for average 29 months. On the last follow-up examination, radiographic changes of grade 1 or 2 of post-traumatic arthritis were seen in twelve wrists and ten of them comptained of pain at wrists. Mean range of motion of wrist joints were 62 of flexion, 64 of extension, 80 of pronation, 77 of supination, 17 of radial deviation and 27 of ulnar deviation. According to the Demerit point system. total 22 of 24 cases(91.7%) showed excellent or good result and there were no poor results. From these
results
, we concluded the die-punch fractures are so unstable comminuted intraarticular fracture on the distal radius with displaced postero-medial fracture fragments on the radiolunate joint, that if we only reduce them anatomically, mostly by open reduction, internal fixation with or without bone grafts, then we could obtain good results.