Anatomic reduction, articular reconstitution, stable internal fixation, and early wrist mtion are key elements in achieving the best possible functional outcomes following fractures of the distal radius. Many methods of surgical treatment have been used to accomplish these goals, including precuatneous Kirshner wire fixation, augmented external fixation, and open reduction and internal fixation using a variety of implants. Recently, the concept of fragment-specific internal fixation has been introduced in the treatment of complex distal radius fractures. Fragment-specific internal fixation refers to the use of limited open surgical approaches and low-profile, anatomically contoured plate constructs to provide rigid fixation of each individual fracture fragment. This article reviews the principles and results of fragment-specific internal fixation in the treatment of these injuries.