Types of die-punch fracture of the distal radius based on three-column theory / 中华创伤骨科杂志

ABSTRACT

Objective To investigate the characteristics and types of die-punch fracture of the distal radius (DPFDR) based on three-column theory as well as its application value.Methods The imaging data of 560 cases of DPFDR were reviewed which had been treated at The Ninth People's Hospital of Wuxi from June 2007 to June 2017.They were 305 males and 255 females,aged from 13 to 95 years,with an average of 46.4 years.According to the three-column theory,the 560 DPFDR cases were divided into a single column group and a double column group.According to the fracture site and morphology,the former was further characterized as volar,dorsal,split and collapse types while the latter as metaphyseal,articular surface and mixed types.After being familiarized with our new classification,2 radiologists were asked to classify 100 cases of DPFDR independently.The inter-and intra-observer agreements were analyzed with Kappa statistics.Results There were 65 cases of single column DPFDR,including 3 ones of volar type,13 ones of dorsal type,14 ones of split type and 35 ones of collapse type;there were 495 cases of double column DPFDR,including 130 ones of metaphyseal type,155 ones of articular surface type and 210 ones of mixed type.The intra-observer Kappa coefficient was 0.877-0.937 and the intra-observer kappa was 0.916-0.959,showing high agreement.Conclusions Due to differences in violence nature and intensity,wrist position and bony quality of the patient at the time of injury,axial violent transmission may cause different types of die-punch fracture at the intermediate column of the distal radius and different types of mild radial column fractures as well.As our new classification may well characterize the site and morphology of DPFDR,it has high consistency to guide surgical treatment and prognosis judgment.