Early Functional Outcomes After Closed Reduction With Pinning Versus Open Reduction Internal Fixation of Wrist Fractures

Inclusion Criteria: * 18 years or greater * Patient functions independently * Dorsally displaced, extra-articular fracture (Colles' fracture); or simple intra-articular fracture with a single split between the scaphoid and lunate facets. * Isolated injury (no other injuries). * One of the following criteria: Substantial initial displacement * Greater than 20 degrees dorsal angulation of the articular surface on the lateral view. * Greater than 100% loss of apposition. * Greater than 5 millimeters of shortening by ulnar variance on the posteroanterior radiograph. * Greater than 2 millimeters articular incongruity (step or gap). * Both dorsal and volar comminution. Inadequate initial manipulative reduction * Greater than 5 degrees of dorsal angulation of the articular surface on the lateral radiograph. * Greater than 3 millimeters of radial shortening by ulnar variance on the posteroanterior radiograph. * Greater than 2 millimeters articular incongruity. * Bayonett apposition of the volar cortex. * Less than 15 degrees of ulnarward inclination of the articular surface in the posteroanterior radiograph. Loss of reduction within 3 weeks of injury. * Any of the following changes in alignment from the initial post- reduction radiographs qualify: * 5 degrees or greater loss of palmar tilt of the articular surface on the lateral radiograph. * 2 millimeters or greater loss of radial height by ulnar variance on the posteroanterior radiograph. * 5 degrees or greater loss of ulnarward inclination of the articular surface of the distal radius on the posteroanteriorradiograph. * 2 millimeters or greater articular incongruity. Exclusion Criteria: * More complex articular fractures (i.e. anything more than a simple sagittal split between the scaphoid and lunate facets). * Volarly displaced fractures. * Infirm patients. * Patients that rely on others for basic functional activities. * Open fractures * Fractures associated with neurovascular injury. * Fractures associated with major head, neurological, or visceral injuries that will inhibit the ability to participate in a structured exercise program. * Associated musculoskeletal injuries to the same arm.