Objeciive To discuss the diagnosis and treatment of comminuted distal radius fractures with inverted atticular surface. Methods Five sides of 4 patients with comminuted distal radius fractures with inverted articular surface were diagnosed by using computerized tomography scanning and 3-dimensional reconstruction technique.The fractures were treated with orthofix external fixator combined with limited intemal fixation. Resuits Correet diagnosis was made in 3 cases preoperatively based on CT scans and 3D reconstruction.Missed diagnosis occurred in 1 case(2 sides).It was diagnosed through reviewing CT scans and 3D reconstruction after the operation.Reduction was achieved and maintained in 3 cases.All the patients were followed-up for 6 to 30 months(12 months on average).According to the anatomical allgnment,3 were excellent,1 good,and 1 fair.Preoperatively,the radial inclination angle was-10°to 15°(12.5°on average)The palmar tilt angle was-25°to 0°(-10°on average).After the operation,the two angels were restored to 20°to 30°(25°on average),and 0°to 20°(11.0°on average)respectively.The joint function Was assessed bv Dienst criteria.the results suggested that 4 were graded as exceHent and 1 as good.No complications such as pin tract infection,pin tract fracture.neurovasculat-injuries,wound infection and osteomyelitis were found. Conclusion Computerized tomography scanning and 3-dimensional reconstruction technique is reliable and necessary for the diagnosis and classification of comminuted distal radius fractures with inverted articular surface.External fixator combined with limited internal fixation is an effective treatment in that it i8 easy to perform.provides reliable fixation.and causes litile complications.