One hundred elderly patients with unstable distal radius fractures were randomized to receive volar plating (n=50) or plaster cast immobilization (n=50). The primary outcome of interest was the complication rate after 12 months. Secondary outcomes of interest included patient-reported outcome measures (Quick-Disability of the Arm, Shoulder and Hand [Quick-DASH]; pain on a Numeric Rating Scale [NRS]; the Patient Rated Wrist/Hand Evaluation [PRWHE]), range of motion, grip strength, and the European Quality of Life 5 Dimensions 3 Levels (EQ-5D) measure. Outcomes were assessed up to 12 months follow-up. The results of this study found no significant differences in primary and secondary outcomes, with the exception of range of motion at 5 weeks and 6 months, which was in favour of the volar plating group. The results of this study indicate the viability of plaster casting as an effective treatment option for the unstable distal radius fractures in the elderly.