Operative treatment for distal radius fractures continues to evolve, but small-fragment fixation has some advantages compared with previous methods. We assessed two groups of patients. Group 1 was an initial series of patients treated with small-fragment fixation at a large institution in the United States, and Group 2 was a review of patients treated in Lund, Sweden. The first group was evaluated for return to routine activity. Return to work or routine daily activity averaged 6 weeks (range, 3-16 weeks). The second group was evaluated for early grip strength and range of motion compared with the uninjured extremity. The grip strength at final followup averaged 67% compared with the uninjured extremity. Wrist flexion averaged 46°, extension averaged 57°, pronation averaged 80°, and supination averaged 73°. Level of Evidence: Therapeutic study, level IV. See the Guidelines for Authors for a complete description of levels of evidence.