In a review of 52 consecutive intra-articular fractures of the wrist (mean age 41 years), 18 developed one of five carpal malalignment patterns. Seven patients developed a volar intercalated collapse pattern. Although showing some loss of motion and/or grip strength, this group remains relatively pain free on follow-up. Patients who developed dorsal translation (six cases) or a dorsal intercalated collapse pattern (one case) were the most symptomatic, with loss of grip strength, decreased range of motion and pain being prevalent.