Diferencia entre revisiones de «Die-punch fracture»
(Added Category:Orthopedics) |
(Removed broken links to non-existent X-ray and CT pages) |
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| Línea 17: | Línea 17: | ||
==Evaluation== | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*Wrist | *Wrist X-ray: PA, lateral, and oblique views | ||
**Look for a depressed articular fragment on the lateral view | **Look for a depressed articular fragment on the lateral view | ||
**Subtle step-off on PA view | **Subtle step-off on PA view | ||
* | *CT scan recommended to fully characterize fracture pattern and articular depression | ||
===Diagnosis=== | ===Diagnosis=== | ||
Revisión del 18:47 19 mar 2026
Background
- Die-punch fracture is a depressed fracture of the lunate fossa of the distal radius
- Caused by axial load transmitted through the lunate onto the lunate facet
- Often occurs with fall on outstretched hand (FOOSH)
- May be associated with other distal radius fractures patterns
- Can be easily missed on plain radiography
Clinical Features
- Wrist pain and swelling after axial loading injury
- Tenderness over the distal radius, particularly the ulnar aspect
- Decreased grip strength
- Limited wrist range of motion (especially extension)
Differential Diagnosis
Forearm Fracture Types
- Distal radius fractures
- Radius and ulna fracture (both-bone forearm fracture)
- Radial head fracture
- Isolated ulna fracture (i.e. nightstick)
- Monteggia fracture-dislocation
- Galeazzi fracture-dislocation
- Essex-Lopresti fracture
- Forearm fracture (peds)
Evaluation
Workup
- Wrist X-ray: PA, lateral, and oblique views
- Look for a depressed articular fragment on the lateral view
- Subtle step-off on PA view
- CT scan recommended to fully characterize fracture pattern and articular depression
Diagnosis
- CT scan is the gold standard for identifying and classifying the fracture
- Fracture involves depression of the lunate facet of the distal radius articular surface
Management
- Non-displaced (<2mm step-off): Sugar tong splint with orthopedic follow-up
- Displaced (≥2mm articular step-off): operative fixation (ORIF) to restore articular congruity
- Early orthopedic consultation for most cases given intra-articular involvement
Disposition
- Discharge with orthopedic follow-up if non-displaced and splinted
- Orthopedic consultation in ED if displaced or significant comminution