Fractures of the distal metaphysis can be transverse, oblique or comminuted. Always confirm the fracture configuration in views from both planes.
Comminuted fractures are often unstable. Irreducible and unstable fractures require ORIF. Other indications for ORIF are open fractures, or soft-tissue lacerations.
Another indication for operative treatment is open fractures and soft-tissue lacerations. In these cases, ORIF is the best option.
Indirect reduction is guided by traction and digital manipulation. When the fracture is stable and reducible, it can be treated nonoperatively. Sometimes indirect reduction may be prevented by interposition of the lateral band. If the fracture is irreducible, ORIF is indicated.