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

OBJECTIVE: This study aimed to assess the efficiency and safety of minimally invasive treatment for die-punch fractures using X-ray parameters. METHODS: 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. RESULTS: 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). CONCLUSION: 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.