The fracture of the distal radius is the most common fracture we treat. Although sometimes stated otherwise, the outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy and biomechanics of the wrist is a prerequisite when treating these lesions. The literature proves that there is a strict relationship between the quality of anatomical reconstruction and the long-term functional outcome. We try to clarify the complex functional anatomy of this region. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities and try to develop strategies in the choice of treatment for different fracture types in different patient groups. Treatment aims should be to reconstruct the anatomy as good as possible, to guarantee that there is no loss of reduction and to allow for a functional after treatment as soon as possible.