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OrthoVellum

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Trauma
intermediate
X-Type

Die-Punch Fractures (Lunate Facet Depression)

Wrist and Hand Trauma

A 45-year-old male presents following a fall onto his outstretched hand from a ladder. He reports wrist pain and swelling. Plain radiographs show a distal radius fracture with minimal displacement on AP view, but lateral view reveals concerning dorsal angulation. CT scan demonstrates a lunate facet depression fracture with 4mm of articular step-off and a separate volar lunate facet fragment. The fragment involves 40% of the articular surface. Three-dimensional reconstruction confirms a die-punch fracture pattern requiring operative intervention. Regarding die-punch fractures:

Mark each as TRUE or FALSE

A

Die-punch fractures are lunate facet depression fractures caused by axial loading of the lunate into...

B

CT scanning is mandatory for die-punch fractures because plain radiographs underestimate articular s...

C

Die-punch fractures with articular step-off less than 1mm can be safely treated with closed reductio...

D

ORIF of die-punch fractures requires fragment-specific fixation with subchondral support, often nece...

E

The dorsal approach (between 3rd and 4th extensor compartments) provides optimal visualization of th...

Answer the questions to see explanations

Click T (True) or F (False) for each option