Operative treatment of intraarticular distal radial fractures.

Intraarticular fractures of the distal radius are difficult to treat successfully by traditional non-operative methods. The goal is to achieve a pain free functional wrist, and residual articular step offs of 2 mm or more will prevent such a result. Classification systems have evolved to reflect the preeminent consideration that must be given to the articular surface, and preoperative radiographic evaluation should usually include tomographic imaging to avoid a failure to recognize the fragment positions. A number of papers of the past decade have demonstrated that operative reduction of intraarticular fragments to reconstruct the articular surface and diminish step offs will give better clinical results, at least during the first several years of followup so far available. Attention to meticulous surgical technique will facilitate good results.