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  Indication for surgical treatment is an unstable fracture resulting from
  

  
  
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    Inadequate alignment after closed reduction
    
    
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    Loss of adequate alignment after manipulative reduction
    
    
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    High likelihood of healing with inadequate alignment with cast alone
    

    
    
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      Fracture displacement, comminution, age, and functional level are related to probability of losing reduction
    
    
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    Inadequate alignment defined as more than 10° of dorsal tilt, more than 3 to 5 mm of ulnar positive variance, or 2 mm or greater articular step-­off
  
  
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  Surgery involves closed or open reduction and internal fixation
  
  
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  An alternative is closed reduction (or repeat closed reduction)

Preoperative Imaging

Plain Radiography

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  PA and lateral radiographs before and after manipulative reduction (Figure 1)
  
  
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  Traction radiographs may be helpful

Computed Tomography

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  Not always indicated, but for certain fracture patterns they may provide further details about number, size, location, and displacement of articular fractures
  
  
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  Three-­dimensional reconstructions are easy to interpret

Procedure

Surgical Technique