Radiocarpal fracture-dislocation was associated with fracture of the distal articular surface of the radius in five patients (six extremities). Closed manipulation resulted in satisfactory reduction of both the dorsal dislocation of the carpus on the distal radius and displaced articular fracture fragment(s) in two of four extremities. In four extremities, open reduction was necessary as the only means of satisfactorily managing this severe wrist injury. Direct visualization through a dorsolateral incision alone allows for maximal restoration of the often extensive bony injury of the dorsal articular surface of the radius. A volar incision is required for anatomic reduction of the carpus, and median reconstitution of the radiocarpal ligament nerve decompression. Functional results were generally satisfactory; however, radiographic degenerative changes appearing early portend traumatic arthritis as a sequela of this complex injury.