In 1989 and 1990, 46 acute distal radius fractures with die-punch compression cavities underwent open reduction and internal fixation using a new compression plate and surgical technique. In 34 of these patients, functional and radiological results after plate removal were studied. Surgical exposure was palmar or dorsal, or combined palmar with a supplementary dorsal incision, depending on the location of the compression cavity and the extent of fracture dislocation. A cortico-cancellous graft from the iliac crest was fitted into the compression cavity, thus supporting the reduced joint surface against the radius shaft. Superior maintenance of the reduction was achieved using cortico-cancellous instead of simple cancellous graft. A new titanius radius reconstruction plate was used for internal fixation. This two-fold support of the fracture allowed for earlier wrist mobilization.