These are complete articular fractures of the distal radius, with no part of the articular surface in continuity with the diaphysis. As these are intraarticular fractures they require anatomic reduction, except in very low demand patients.
If the intraarticular component is a single split, with relatively little comminution it may be possible to obtain a closed reduction. If this is not possible or there are associated injuries open reduction is recommended.
Any patient who has had a fall on the outstretched hand may have sustained an intercarpal ligament injury; these may easily be missed on initial clinical assessment.
Note: CT scans may be helpful for treatment decisions.
Special attention must be paid to fractures with a dorsomedial fragment. The dorsomedial fragment is part of the radiocarpal and the distal radioulnar joint and should be reduced anatomically. If the fragment does not reduce after closed reduction with ligamentotaxis, percutaneous manipulation with a K-wire or formal open reduction and internal fixation (dorsal double plating) may be required.