in patients with high functional demand, and in this case, more stable fixation techniques should be used. Surgical options have been shown to be successful in patients with unstable extra-articular or minimal articular distal radius fractures. These options include percutaneous pinning, external fixation, and ORIF using plating. Patients with low functional demand of their wrists can be treated successfully with nonsurgical management; however, in more active and fit patients with fractures that are reducible by closed means, nonbridging external fixation is preferred, as it has less serious complications when compared to other surgical options. The most common complication associated with nonbridging external fixation is pin tract infection, which can be managed with antibiotics and frequent dressing changes, and rarely results in reoperation. The external fixator is placed for 5 to 6 weeks and can be removed in an outpatient setting. If the fractures are unlikely to be reduced by closed means, open reduction with internal plate fixation is preferred. Although major complications (i.e. tendon injury, fracture collapse, or malunion) result in higher reoperation rates (36.5%) compared to external fixation (6%), ORIF is preferred, as this provides better stability and restoration of the volar tilt. Following the operation, a removable splint is placed for 2 weeks, during which time patients should mobilize the wrist as tolerated. Displaced intra-articular fractures These fractures, although less common, often require surgery in active, healthy patients to address displacement of both the joint and the metaphysis. The two mainstays of treatment are bridging external fixation or ORIF. If reduction can be achieved by closed/percutaneous reduction, then open reduction can generally be avoided. Percutaneous pinning is preferred to plating due to similar clinical and radiological outcomes, as well as lower costs, when compared to plating, despite increased risk of superficial infections. Level of joint restoration, as opposed to surgical technique, has been found to be a better indicator of functional outcomes. Outcome World Health Organization (WHO) divides outcomes into three categories: impairment, disabilities, and handicaps. Impairment is the abnormal physical function, such as lack of forearm rotation. It is measured clinically. Disability is the lack of ability to perform physical daily activities. It is measured by Patient Reported Outome Measures (PROMs). Examples of scoring system based on clinical assessment are: Mayo Wrist Score (for perilunate fracture dislocation), Green and O’Brien Score (carpal dislocation and pain), and Gartland and Werley Score (evaluating distal radius fractures). These scores includes