OBJECTIVE In this prospective study we have analysed the clinical outcome of complex distal radius fractures that were reduced by a dorsal approach and fixed with 2 dorsal locking plates. METHODS In the period from January 2006 to June 2008 60 patients with a distal intra-articular instable radius fracture, who were treated with the above mentioned procedure, were prospectively included in this study. All fractures showed signs of a complex and dorsal instability. X-rays and CT scans were taken preoperatively. Follow-up examinations and X-rays were conducted after 6 weeks, 6 months and 1 year. The clinical outcome was measured with the aid of the disability of arm, shoulder and hand (DASH) score (0-100 points). The functional outcome was measured with the Gartland and Wearley score (0-21 points). Subjective pain levels were noted with the visual analogue scale (0-10 points). RESULTS 60 patients were examined after 6 weeks and 6 months. 40 patients were examined after 1 year. The average age was 56 (range: 16-78 years). In 36% of the cases we found an accompanying injury of the upper extremity that had to be treated operatively. The DASH score improved on average from 47 points after 6 weeks (28 points after 6 months) to 24 points after 1 year. The subjective pain level after 1 year was 2.4 points under stress and 1.1 points in relaxation. The Gartland and Wearley score showed an improvement of function of the wrist from 9.9 points after 6 weeks to 7.4 points after 1 year, which is considered a good result. In 12 cases reoperations were necessary, in 6 cases due to a postoperative carpal tunnel syndrome (10%) and in 1 case due to an infection of the wound. CONCLUSIONS Dorsal instable radius fractures can be stabilised in a satisfactory way. It is possible to achieve good results, assuming an exact analysis of the fracture and of the associated injuries is performed.