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Fractures of the distal radius are common and account for approximately 75% of all fractures of the forearm. Young athletes involved in high-velocity injuries to the wrist often sustain comminuted intra-articular distal radius fractures, which can produce great challenges to the physicians treating them. The comminution of the cortex and distal fragment frequently involve the distal radioulnar joint and radio-carpal joint, and inadequate treatment may result in functional limitation and chronic pain. The authors describe a systematic approach to evaluation and treatment of distal radius fractures, the indications and techniques for various types of surgery, and potential complications.