Distal radial fractures in patients who are younger than the age when osteoporosis usually develops are different from fractures in the elderly. Arthroscopy has revealed these fractures often have a complex pattern of fracture related chondral and ligament injuries in the wrist. In Lund, Sweden, of the 92 distal radial fractures that occurred during 1 year in patients younger than the age when osteoporosis usually develops, 76 patients were assessed after more than 1 year (range, 14-38 months). The examination included questions, a visual analogue scale for pain, a physical examination, bilateral radiographic assessment, and wrist score determination according to Gartland and Werley. Instability at clinical examination of the distal radioulnar joint was associated with a worse wrist score and doubled the visual analogue measures for pain at rest and pain at load. This instability was not correlated to any radiographic variable at the time of fracture or at followup. The distal radioulnar joint was painful in 17 of the 27 patients with instability. Radiographic scapholunate dissociation did not affect the outcome. However, radiographic osteoarthrosis Grade 1 was associated with a worse wrist score. The outcome was dependent on the stability of the distal radioulnar joint, which in turn was not correlated to any radiographic parameter. Thus, destabilizing ligamentous injuries are thought to be an important cause of residual problems.