Severe intra-articular fractures of the distal radius with comminuted, displaced, and malrotated fragments are the most challenging fracture patterns. Reconstruction faces 3 major problems: fixation of fragments that are too small for stabilization by standard plates or screws, restoration of substantial cartilage loss in the articular surfaces, and extended metaphyseal/subchondral bony defects. For addressing these problems, a strategy is reported, by applying small, subchondrally placed Kirschner wires for the realignment of the articular surfaces, temporary inlay of a silicone foil in case of lost articular cartilage, and iliac crest bone grafting for bony defects. Stability is further augmented by buttress plates. This study reviews the historical perspective, indications, technique, complications, and rehabilitation of this strategy.