Treatment of complex fractures of the distal radius. Combined use of internal and external fixation and arthroscopic reduction.

A group of fractures of the distal radius are inherently unstable and cannot be treated by closed reduction and cast or external fixation. These fractures are high-energy motor vehicle accidents often seen in young adults but possible in nearly every age group. They are not typical Colles's fractures because they are intra-articular with displacement of the joint articular surfaces. The goals of treatment are to obtain an anatomic reduction and then to proceed with treatment techniques to maintain the reduction by whatever methods are available or necessary within the experience of the treating surgeon. Previous admonitions that Colles's fractures should not be treated by open reduction are incorrect. Like other intra-articular fractures, the goal is anatomic alignment. Limited open reduction or newer arthroscopic techniques may be sufficient. A more aggressive approach of open reduction, internal and external fixation, and autogenous bone grafting is now indicated in most high-energy distal radius fractures to achieve the treatment goals defined earlier: anatomic joint surface reduction, restoration of radial length, and correction of dorsal malangulation.