Objective To investigate the early clinical effect of osteotomy combined with bone graft internal fixation in the treatment of malunion of extra-articular distal radius fractures. Methods From June 2014 to December 2018, 12 patients with malunion of extra-articular distal radius fractures were selected.Postoperative fracture healing time, postoperative radial length, radial palmar inclination angle, ulnar deviation angle, visual analogue scale, modified Mayo wrist score and Cooney score were recorded, and surgical complications were recorded. Results 12 patients were followed up for 9-24 (18.50±3.70) months. There was no significant difference in postoperative healing between metacarpal displaced deformity and dorsal displaced deformity (P > 0.05). There were significant differences in postoperative metacarpal inclination angle, dorsal displaced palmar inclination angle, radial length, ulnar deviation angle, VAS score, modified Mayo wrist score and Cooney score (P < 0.05).Postoperatively, 1 patient developed hallux extensor tendinitis. Conclusion Extra-articular distal radius fracture malunion treated with extra-articular osteotomy and iliac structural fixation is effective and worthy of clinical application.