Distal radius fracture is one of the most common fractures in orthopedics, accounting for about 1/6 of fracture patients. With the rapid development of transportation and construction industries, the number of distal radius comminuted fractures due to high-energy injury has increased significantly. Our hospital treats high-energy injury distal radius comminuted fractures with limited incisional repositioning external fixation frame combined with gristle pin fixation. Diagnosis: The typical wrist deformity and radiographs confirmed the diagnosis. Treatment: All procedures were performed under brachial plexus anesthesia with the patient in the supine position. Two external fixation pins were drilled in the middle radius and 2 metacarpals, and the forearm was placed in the posterior or anterior rotated position according to the direction of displacement of the distal radius comminuted fracture. The intra-articular fracture was repositioned with the aid of a limited incision to restore the palmar tilt angle and ulnar deviation angle, and the articular surface was repositioned anatomically as far as possible, and the bone block of the articular surface was crossed and fixed from distal to proximal through the percutaneous kerf pins to maintain the stability of the intra-articular fracture after repositioning. Postoperatively, antibiotics were routinely applied to prevent incisional infection. Interphalangeal joint, metacarpophalangeal joint, shoulder and elbow joint activities were started 2 days after surgery, and regular review was performed. After the fracture reached clinical healing, the external fixation frame was removed 6-8 weeks later for functional exercise of the wrist joint. Discussion: The necessity of limited incisional repositioning High-energy injury is a common cause of distal radius comminuted bone in young and middle-aged people. High-energy injury often causes distal radius fractures with the following characteristics: joint surface comminution, radial carpal joint subluxation, shortening or comminution of the radial epiphysis, etc. If the treatment is not properly repositioned, it will lead to severe wrist joint malfunction, which may affect the working ability for young and middle-aged patients. Therefore it is especially important to choose a reasonable means of repositioning. Theoretically, the reduction of distal radius comminuted fracture should achieve: restoration of radius length, anatomical repositioning of intra-articular fracture, restoration of distal radius palmar inclination and ulnar deviation angle. The cases in this group are all intra-articular comminuted fractures of the distal radius caused by high-energy injury, and traction reduction can only partially restore the length of the radius, and it is difficult to achieve anatomic reduction of the intra-articular fracture, and poor joint surface reduction is the main factor causing traumatic arthritis. Therefore, many scholars choose to treat intra-articular fractures by incisional reduction, and Jiang Baoguo et al [4] reported that incisional reduction is beneficial to articular surface repositioning, and the postoperative excellent is 83.3%. In this group, all of the fractures were obviously displaced at the articular surface, and limited incision was chosen to assist in the reduction of the articular surface under direct vision, which obviously improved the rate of anatomical reduction of the articular surface. The limited incision is based on the location of the intra-articular fracture mass to select the dorsal or palmar approach, to reveal the joint surface to be repositioned in a limited manner, and to apply a kerf pry to assist in the repositioning, and to evaluate the success of the repositioning by C-arm X-ray fluoroscopy. The limited incision reduces the disturbance of soft tissues and less periosteal stripping. Compared with the traditional incisional repositioning, it reduces the chance of surgical trauma and incisional infection, facilitates fracture healing, and achieves precise repositioning of the articular surface, which I believe is a worthy improvement of the surgical technique. Advantages of external fixation combined with kerf fixation In 1991 Jakim [5] in Anderson and Oneil [6] and others used external fixation to treat comminuted fractures of the end of the radius to obtain good results; excellent and good rate of 83%, and that external fixation of bone set significantly better than plaster, internal fixation and other methods. More and more scholars believe that external fixation technique is an effective means of treating distal radius comminuted fractures [4], the fractures in this group are all high energy injury bone comminuted severely, not only the epiphyseal cortical comminuted fracture is displaced but also the articular surface fracture is displaced severely, the simple external fixation of plaster by manual repositioning cannot maintain the reset stability, and the comminuted fracture cannot provide support for the internal fixator. External fixation can effectively maintain the reduction of the distal radius fracture and overcome the tendency of shortening, and the application of percutaneous limited internal fixation with Kirschner pins will significantly increase the stability of the articular surface after reduction. In this group, external fixation combined with Kirschner’s pin fixation technique was used to maintain the stability of the articular surface fracture after repositioning and the normal length of the radius by the traction of the external fixator, allowing the wrist joint to be fixed in a functional or neutral position, which is more conducive to early functional hand exercise, promoting the reduction of local soft tissue swelling and preventing tendon adhesions. The relative stability of the fracture after external fixation combined with kyphosis pin fixation is good, allowing early functional exercise of the elbow and shoulder joint and preventing the occurrence of hand and shoulder syndrome. It is beneficial to improve the long-term functional recovery. Complications of external fixation combined with Kirschner’s pin fixation There are also shortcomings and complications of external fixation frame combined with Kirschner’s pin fixation, the more common ones are: 1) Intraoperative injury to the superficial branch of radial nerve, one case in this group showed intractable local pain allergy after surgery, which was relieved after 3 months of conservative treatment after removal of fixation; this is related to the location of external fixation pin placement, the normal superficial branch of radial nerve travels between the radial longissimus dorsi muscle and brachioradialis muscle, and the choice of this gap is a result of pin placement. (2) Needle infection is related to long-term exposure of the needle eye and needle foreign body reaction, which can be avoided by strengthening needle eye care and changing medication, and the two cases in this group healed rapidly after removal, without deep infection; (3) The withdrawal of the needle is related to early functional exercise of the hand, which will easily lead to loss of the fracture after repositioning and cause deformity healing.