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OBJECTIVE Compare the volar Henry and dorsal Thompson approaches with respect to outcomes and complications for proximal third radial shaft fractures. DESIGN Multi-center retrospective cohort study. PATIENTS/PARTICIPANTS Patients with proximal third radial shaft fractures ± associated ulna fractures (OTA/AO 2R1 ± 2U1) treated operatively at 11 trauma centers. INTERVENTION Demographic patient, injury, fracture, and surgical data were recorded. Final ROM and complications of infection, neurologic injury, compartment syndrome, and mal/non-union were compared for volar vs. dorsal approaches. MAIN OUTCOME Difference in complications between patients treated with volar versus dorsal approach. RESULTS At an average follow up of 292 days, 202 patients (range, 18-84 years) with proximal third radial shaft fractures were followed through union or nonunion. 155 were fixed via volar and 47 via dorsal approach. Patients treated via dorsal approach had fractures that were on average 16mm more proximal than those approached volarly, which didn't translate to more screw fixation proximal to the fracture. Complications occurred in 11% of volar and 21% of dorsal approaches with no statistical difference. CONCLUSION There was no statistical difference in complication rates between volar and dorsal approaches. Specifically, fixation to the level of the tuberosity is safely accomplished via the volar approach. This series demonstrates the safety of the volar Henry approach for proximal 1/3 radial shaft fractures. LEVEL OF EVIDENCE III.