Introduction: The purpose of this paper is to describe our management of complex fractures of the distal radius and ulna using a combined type of stabilization, external with a Pennig fixator, internal with radial augmentation with plate. The patient have sustained a several general trauma or an high energy scheletral trauma upper limbs.

Treatment: In a period from 24 July 2002 to today 8 October 2004 (26 months) we have treated surgically 93 wrists with distal radial fractures in 85 patient.

The main problem, in the follow up results is a lack of pronosupination that stresses the importance of a perfect reduction of distal radioulnar joint to begin early a phisiotherapy

Clinical results: In conclusion our experience in timing of treatment indicate that is important fixate the lesions earlier, whenever the priority of treatment on severely injured patients are respected

We believe that a combination of the two fixation system allow an optimal external stabilization in the first week (So the therapist can move the patients in intensive care room). Secondary the internal fixator allows an anatomical reduction with a stable fixation in the secondary kinesiterapeutic time.

Dislocation and carpal fracture-dislocation are a rare injury, interesting capsula and ligaments, with a variable damage of the vascularization. Classification is difficult for the complexity on this lesion.

The aim of our work is to underline how the best final clinical result is achieved after an immediate treatment of reduction and stabilization of bone injury.

We considered two groups:

A: 13 patients, who have been observed since 1991 until 1998:

B: Another group is at short term is since July 2002 until 2005 and is in 20 patients with 21 wrists 1 is bilateral.

Finally we think that is necessary, to avoid the instability and pseudoartrosis on the scaphoid, to treat all the transcapholunate dislocation with open reduction and stabilisation, as agreed with literature.