Fractures with severe comminution of the joint surface and with little metaphyseal support to the volar rim fragments may benefit from a volar buttress plate in addition to ligamentotaxis served by an external fixator. The most severe, comminuted fractures however should be subject to augmented external fixation. If a CT-scan reveals bone fragments of a size that can be captured by (multidirectional) screws, plate fixation is an alternative. If not, these fragments may be fixated by K-wires through an open approach, or simply left in place. The documentation is poor, but the combination of plate fixation and external fixator can produce a satisfactory outcome in the most comminuted fractures. Given the possible, combined complications of the two methods, it should be an option only when adequate reduction and stability cannot be achieved by one method alone.