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This prospective study assessed the outcomes of 26 symptomatic malunited distal radial fractures which were treated with an opening wedge corrective osteotomy and bone grafting with rigid fixation. An ulnar shortening osteotomy was subsequently required as a second-stage operation in five cases to restore normal ulnar variance. A wrist arthroscopy was indicated as a third stage procedure with persistent ulnar sided wrist pain in order to address central tears of the triangular fibrocartilage. Satisfactory functional scores were achieved by 20 of the 26 patients after distal radial osteotomy alone and, 24 of the 26 after subsequent ulnar shortening osteotomies and arthroscopy when necessary. The one, two or three stage concept of reconstructing the malunited distal end radius could optimise the outcome rather than using a single-stage strategy.