Minimally Invasive Treatment of Die-Punch Fractures and Related X-Ray Parameters

This study aimed to assess the efficiency and safety of minimally invasive treatment for die-punch fractures using X-ray parameters.

From May 2020 to May 2022, 32 patients (32 wrists; minimally invasive group) underwent percutaneous bony distraction, followed by external fixation. For comparison, we retrospectively reviewed another 35 patients (35 wrists; plating group) who underwent open reduction and internal fixation with plate and crew systems. Wrist movement was assessed. X-ray parameters and wrist pain were assessed. Wrist function was assessed using the Mayo Wrist Score. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction.

The mean age of the minimally invasive group was 38.6±12.3 years (range, 24-52 years). There were types B3 (n=11), C1 (n=10), C2 (n=8), and C3 (n=3). Bone healing achieved in all patients after 5.8±1.6 weeks. The mean age of the plating group was 37.1±13.2 years (range, 27-50 years). There were types B3 (n=13), C1 (n=9), C2 (n=9), and C3 (n=4). Bone healing achieved in all patients after 6.3±1.6 weeks. Two years after surgery, there were significant differences in radial height (12.1±2.6 mm versus 10±2.5 mm; p<0.05) and ulnar variance (0.7±0.5 mm versus 1.4±0.9 mm; p<0.05). There was a significant difference in wrist pain (0±1 versus 3±3; p<0.01). There was no significant difference in wrist movement (p>0.05), grip strength (p>0.05), Mayo Wrist Score (p>0.05), or patient satisfaction (p>0.05).

When treating die-punch fracture of distal radius, directly lifting the collapsed fragments through percutaneous bone distraction can effectively achieve reduction. The carpal bones can be used as a template to restore the alignment of the articular surface of the distal radius. External fixation can prevent re-collapse of the radius. The treatment can be an alternative technique, in addition to open reduction and plating.