A review of 18 patients treated at our institution for open distal radius fractures was performed. The patients were followed up for an average of 32 months (range, 12 months to 5.3 years). Wounds were classified according to Gustilo and Anderson with 9 type I (50%), 3 type II (17%), and 6 type III (34%) (3 IIIa, 2 IIIb, 1 IIIc) injuries. Seven patients underwent a total of 2 to 4 procedures to treat their injuries, and 3 patients required 5 or more procedures. Eleven (61%) patients had postoperative complications. Patients were evaluated with the Disabilities of the Arm, Shoulder, and Hand questionnaire and scored an average of 33. Wound severity was associated with an increased number of postoperative complications (p =.012), an increased number of complications per patient (p =.015), a higher number of surgical procedures (p =.003), a decreased average range of motion (p =.235), and fair or poor results at the latest follow-up (p =.03). Although type I injuries may be similar to their closed counterparts, patients with type III injuries experienced a much greater number of initial complications and had worse long-term clinical outcomes.