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Musculoskeletal
Diagnosis
Trauma
Wrist and Hand
Bones and Joints
Distal Radius and Ulna
Die-Punch Fracture
Die-Punch Fracture
Carol L. Andrews, MD; Kambiz Motamedi, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Lunate fossa loading fracture, radiolunate fracture, scaphoid die-punch fracture

              • Definitions

                • Axial impaction of carpal bone(s) into distal radius (DR) articular surface
                  • Most commonly, lunate into lunate fossa
                  • Scaphoid may impact scaphoid fossa in isolation or in addition to lunate impaction injury
                  • Splits articular surface in coronal and sagittal planes
                  • Die-punch terminology originates from machinery technique to shape hole in material

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Ma Y et al: Image classification for die-punch fracture of intermediate column of the distal radius. Radiol Med. 122(12):928-33, 2017
                                          2. Kamal Y et al: Functional outcome of distal radius fractures managed by barzullah working classification. Arch Trauma Res. 4(1):e20056, 2015
                                          3. Falcochio DF et al: What is the best radiographic view for "die punch" distal radius fractures? A cadaver model study. Rev Bras Ortop. 47(1):27-30, 2012
                                          4. Diaz-Garcia RJ et al: A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 36(5):824-35.e2, 2011
                                          5. Makhni EC et al: Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 33(8):1301-8, 2008
                                          6. Anderson DD et al: A three-dimensional finite element model of the radiocarpal joint: distal radius fracture step-off and stress transfer. Iowa Orthop J. 25:108-17, 2005
                                          7. Yamamoto K et al: Clinical results of external fixation for unstable Colles' fractures. Hand Surg. 8(2):193-200, 2003
                                          8. Goldfarb C et al: Wrist fractures: what the clinician wants to know. Radiology. 219:11-28, 2001
                                          9. Trumble TE et al: Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 48:465-80, 1999
                                          10. Melone CP Jr: Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 24(2):239-53, 1993
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Lunate fossa loading fracture, radiolunate fracture, scaphoid die-punch fracture

                                                      • Definitions

                                                        • Axial impaction of carpal bone(s) into distal radius (DR) articular surface
                                                          • Most commonly, lunate into lunate fossa
                                                          • Scaphoid may impact scaphoid fossa in isolation or in addition to lunate impaction injury
                                                          • Splits articular surface in coronal and sagittal planes
                                                          • Die-punch terminology originates from machinery technique to shape hole in material

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Ma Y et al: Image classification for die-punch fracture of intermediate column of the distal radius. Radiol Med. 122(12):928-33, 2017
                                                                                  2. Kamal Y et al: Functional outcome of distal radius fractures managed by barzullah working classification. Arch Trauma Res. 4(1):e20056, 2015
                                                                                  3. Falcochio DF et al: What is the best radiographic view for "die punch" distal radius fractures? A cadaver model study. Rev Bras Ortop. 47(1):27-30, 2012
                                                                                  4. Diaz-Garcia RJ et al: A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 36(5):824-35.e2, 2011
                                                                                  5. Makhni EC et al: Effect of patient age on the radiographic outcomes of distal radius fractures subject to nonoperative treatment. J Hand Surg Am. 33(8):1301-8, 2008
                                                                                  6. Anderson DD et al: A three-dimensional finite element model of the radiocarpal joint: distal radius fracture step-off and stress transfer. Iowa Orthop J. 25:108-17, 2005
                                                                                  7. Yamamoto K et al: Clinical results of external fixation for unstable Colles' fractures. Hand Surg. 8(2):193-200, 2003
                                                                                  8. Goldfarb C et al: Wrist fractures: what the clinician wants to know. Radiology. 219:11-28, 2001
                                                                                  9. Trumble TE et al: Intra-articular fractures of the distal aspect of the radius. Instr Course Lect. 48:465-80, 1999
                                                                                  10. Melone CP Jr: Distal radius fractures: patterns of articular fragmentation. Orthop Clin North Am. 24(2):239-53, 1993