Techniques for reduction and fixation of intra-articular distal radius fractures have improved in recent years such that fractures that were once thought doomed to a poor result may now be successfully treated operatively. This article explores open, semi-open, and arthroscopically assisted techniques for reduction and fixation of complex distal radius fractures. The reader should gain an appreciation of which fractures can benefit from operative treatment and which techniques may be most useful for specific fracture types. A number of fixation techniques are described, and familiarity with diverse methods will aid the surgeon in complex cases.