The die-punch radial fracture is a two-part, impacted, intra-articular fracture of the distal radius.
Location: lunate fossa of the distal radius. This is in the midline of the wrist at the end of the radius abutting the distal ulnar bone.
Mechanism: transverse load through the lunate (with proximal displacement of the lunate)
The load results in a fracture of the distal radius typically with a depressed fragment being displaced towards the ulna. The remaining radius has a small "step" at its distal end.
The fracture may affect the stability of the carpal arc I.
The radiographic appearance may be subtle.
Management may require an open procedure.
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