Four randomized controlled trials (RCTs) including 423 elderly patients (aged ≥ 60 years) with displaced distal radius fractures (DRFs) were included in this systematic review and meta-analysis comparing volar locked plate (VLP) fixation versus closed reduction and casting (CRC). Pooled outcomes of interest included the Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, EuroQol 5 Dimension 5-level score (EQ-5D-5L), grip strength, and incidence of reoperation. VLP fixation was associated with statistically significant improvements in PRWE score, DASH score, and grip strength, but no significant differences in EQ-5D-5L scores or reoperation rates. Despite some functional advantages of VLP fixation, no significant long-term clinical benefit was demonstrated over CRC.