Fig. 12. Fixation of distal radius fractures. No universal system exists, and the surgeon should be familiar with several systems to deal with the variety fracture patterns. (1.) Distraction with external fixation supplemented with percutaneous Kirschner wires. (2.) Distraction using a temporary plate and screws, tunnelled between two small access incisions. (3.) Open reduction with a buttress plate. (4.) Open reduction with the Medoff fixation system.