Based on this review, it is evident that the anatomic results obtained by the use of pins and plaster for the treatment of comminuted distal radial fractures is insufficient to yield a high percentage of satisfactory functional end results. In addition, the high complication and reoperation rate noted in our series makes us question whether the technique of pins and plaster should remain a treatment option for these difficult fractures. Perhaps a combination of internal fixation with bone grafting combined with external fixation will provide a solution to this fracture, particularly in young, active patients.