Backround: To present the results in a series of patients with complex distal radius fractures featuring comminution of the articular surface and the metaphysis in whom we used a volar as well as a dorsal approach in order to control the axial alignment and reconstitute the articular surface.

Material: There were sixteen patients with an average age of 26 years. All the fractures were classified as C3 according to AO Universal Classification. All the patients underwent an open reduction and internal fixation through a dorsal as well as a volar approach. Secondary operations were necessary for five patients.

Results: The average extension was 56, the average flexion was 51, pronation 70 and supination 76. The grip strength was 75% of the contralateral hand. The average ulnar inclination was 20°, 3 dorsal inclination, 0.9 mm ulnar variance and 1 mm articular incongruity. Three patients had radiological signs of radiocarpal arthritis. Excellent or good results achieved in the 40% of the patients according to the system of Green and O’Brien

Conclusion: The combination of dorsal and volar approach it is necessary for the carpus to be well aligned in order to achieve stability and give the opportunity for early mobilization. Sometimes additional operations are necessary.