Classification by Column and Type of the Generalized Distal Radius Die-Punch Fractures

Abstract Background:  There was no three-column classification for generalized distal radius die-punch fractures (GDP) which can involve three-columns. The aim of this study was to investigate the classification by three-column and type of GDP. Methods：613 patients with GDP accrued from January 2013 to December 2021 were classified by column and fracture type. First, the GDP were separated into single-, double-, or three-column fractures. Second, the intermediate column fractures were categorized into volar, dorsal, split, collapse or mixed type, the radial column fractures were categorized into metaphyseal, articular or mixed type, and the ulnar column fractures were categorized into styloid process or metaphyseal type. Observing the classification results. The intra‑ and inter‑observer consistency between two assessors was analyzed with kappa statistics.Results：There were significant differences in the incidence (12.7%, 68.5% and 18.8%, respectively) and age (39.8, 46.6 and 47.1 years, respectively) for single-, double- and three-column fractures but no significant difference in terms of gender among the three (P>0.05). The mixed, collapse, split, dorsal and volar types were 28.7%, 27.7%,21.9%, 15.5% and 4.5%, respectively. The metaphyseal, articular surface and mixed types were 35.9%, 33.1% and 31.0%, respectively. The styloid process and metaphyseal types were 81.7% and 18.3%, respectively. Among the cases of volar and dorsal types, the missed diagnosis rate of X-ray was 28.5%. To the last follow-up of 12.2 months (range, 6 to 24 months), the wrist function was evaluated according to the Sarmiento modified Gartland-Werley method, the excellent plus good rate of the single column fractures was 96.2%, significantly higher than that of double- and three- column fractures (80.0% and 83.5%, respectively) (P<0.05). All patients that had poor wrist function were collapse or mixed type intermediate column fractures. The intra‑observer kappa coefficient was between 0.810 and 0.861 and the inter‑observer kappa coefficient was between 0.830 and 0.876.Conclusion：Different types of GDP have significant differences in terms of injury mechanism, incidence, age and prognosis. Classification by column and type of GDP reflects the features and has important reference value for clinical diagnosis and treatment.