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It is challenging to restore the clinically acceptable alignment of the distal radius after an acute on chronic fracture or after a secondary fracture occurring after malunion of a primary distal radius fracture. In cases of insignificant primary deformity, restoration to the primary deformity may suffice to obtain a successful clinical result. A borderline acceptable primary radial deformity can be unacceptable after the second injury, resulting in functional disability. If surgery is indicated, the surgeon must contend with both primary and secondary deformities to restore proper distal radius anatomy. We present our technique to correct both primary and secondary distal radius deformities through the new or secondary fracture plane., Competing Interests: Conflicts of Interest and Source of Funding: Irrevocable trusts of which J.L.O. and family members are the beneficiaries own stock in Skeletal Dynamics, and the company reimburses expenses when he speaks or presents on the company’s behalf. D.M.M. discloses speaker’s bureau for Skeletal Dynamics and Axogen. For the remaining authors none were declared., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Locked volar plating is the most common surgical procedure to address distal radius fractures. The extended flexor carpi radialis approach continues to be an excellent method for visualizing distal radius fractures and applying a volar plate. A new understanding of the anatomy allows for better visualization and reduction of the many different distal radius fracture patterns surgeons commonly see. Within the extended flexor carpi radialis approach, we describe the radial septum in further detail including the anatomy which comprises the radial septum triangle. Knowledge of this area allows for better visualization, more anatomic reductions, and fewer complications.