10 patients with malaligned fractures of the distal radius that demonstrated either delayed healing or the development of an atrophic or synovial nonunion on standard radiographs were treated with surgical realignment, stable internal fixation, and autogenous iliac crest bone grafting. All 10 fractures healed with acceptable radiologic alignment within 6 months of the index procedure. After an average follow-up period of 3 years (range, 2 years to 5 years) patients had an average of 90° wrist flexion and extension, 150° forearm rotation, and 70% grip strength compared with the opposite limb. In the treatment of malaligned, non-united fractures of the distal radius, specific techniques and implants must be tailored to the deformity of the distal radius and the shape of the distal fragment. A stable,well-aligned wrist with preservation of at least 50° mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 2 patients. Key words: Distal radius, wrist, nonunion, bone graft, internal fixation.