6 randomized controlled trials were included in the meta-analysis comparing the efficacy of closed reduction and external fixation (EF) with volar locking plate (VLP) fixation in the management of unstable distal radius fractures. Clinical outcomes, radiological outcomes, and complications were pooled over the first 12 months postoperatively. Pooled results favoured volar locked plating for 3-month functional recovery through patient-reported measures, grip strength, and range of motion. However, no significant differences in pain or function were observed between fixation methods at 12 months, with the exception of outcome on the Disabilities of the Arm, Shoulder, and Hand (DASH), which continued to favour VLP fixation. Reoperation rate was significantly higher following volar plating compared to external fixation.