Abstract: BACKGROUND: For most Die-punch fractures of the distal radius, functional reset can be achieved by manual closed reduction. However, most of these injuries are young and middle-aged patients. They have higher requirements for wrist joint function after fracture healing. It remains poorly understood whether surgical treatment can achieve better results. 
OBJECTIVE: To analyze the clinical effect of surgical treatment and conservative treatment of distal middle column Die-Punch fracture. 
METHODS: Totally 41 cases of Die-punch fractures of the volar side of the medial column of the distal radius were selected from the Second Hospital of Shanxi Medical University from January 1, 2010 to December 31, 2020. In the conservative treatment group (n=19), patients underwent manual reduction and plaster external fixation. In the surgical treatment group (n=22), patients underwent open reduction and internal fixation with metal locking plate. At 1 year after surgery, the patients underwent X-ray to measure the palmar angle, ulnar deviation angle and radius height. The stability of the wrist joint was assessed by Scapolunate angle, radial angle, and capitolunate angle. Pathological wrist subluxation was assessed by effective radioscapholunateflexion angle to measure wrist range of motion. Wrist joint function was assessed by the disabilities of arm, shoulder and hand score and Mayo score. 
RESULTS AND CONCLUSION: (1) The mean follow-up time was 14.5 months in 41 patients, and the mean bone healing was 8.5 weeks. There were no complications such as loosening and fracture of internal fixation. (2) At 1 year after surgery, the palm inclination angle and wrist flexion angle of the patients in the surgical treatment group were greater than those in the conservative treatment group (P < 0.001). Radial height settlement value was less in the surgical treatment group than that in the conservative treatment group (P < 0.001). Wrist instability rate was lower in the surgical treatment group than that in the conservative treatment group (18%, 79%; P <0.001). There was no pathological subluxation of the wrist joint in the surgical treatment group and four cases of pathological subluxation of the wrist joint in the conservative treatment group, and there was a significant difference between the two groups (P < 0.001). (3) One year after surgery, disabilities of arm, shoulder and hand score in the surgical treatment group were lower than those in the conservative treatment group (P < 0.001), and the Mayo score was higher than that in the conservative treatment group (P < 0.001). (4) The results suggest that compared with conservative treatment, open reduction and internal fixation for distal middle column palmaral Die-punch fracture can achieve more stable wrist joint and better wrist joint function. 

Key words: metal locking plate, distal radius, press fracture, three-column theory, axial violence, wrist dislocation, traumatic arthritis