Presentation
Six weeks post left distal radius fracture.
Patient Data
Left metaphyseal transverse fracture of the distal radius with interval partial healing as demonstrated by sclerosis of the fracture line. Some impaction with positive ulnar variance. Joint space narrowing of the radioscaphoid articulation with joint incongruity and small articular step represents a die-punch component to the fracture.
Advanced 1st carpometacarpal degenerative changes. Generalized osteopenia.
Prior to cast removal the fracture was undisplaced. Degree of healing difficult to assess due to overlying cast.
Case Discussion
A die-punch fracture results from axial loading forces on the distal radius. It is an intra-articular fracture of the lunate fossa of the distal radius 1. It is by definition depressed or impacted and is named after the machining technique of shearing a shape, depression or hole in a material with a die implement or cutter. The die-punch mechanism classically involves the lunate fossa of the radius but can occur from any loading injury 2.
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