Strategies for Specific Reduction in High-Energy Distal Radius Fractures

High-energy distal radius fractures frequently result in comminution with intra-articular fragmentation. Knowledge of predictable patterns of injury allows the surgeon to develop a preoperative plan for anatomic reduction and stable fixation of individual fragments that are too small or too distal to be fixed with standard volar locked plating. We review the column model, which organizes the distal radius into an intermediate column, radial column, and pedestal as the basis of a reconstructive algorithm and emphasize the importance of the volar ulnar fragment. Specific reduction and fixation techniques are described to assist the surgeon in treating these injuries.