40 elderly patients (>65 years) with a distal radius fracture of AO type A2, A3, or C1 were randomized to undergo either palmar fixed-angle plate fixation or minimally-invasive K-wire fixation. The purpose was to compare these two treatment approaches with respect to functional, clinical and radiological outcomes. Results indicated that K-wire fixation yielded a significantly shorter operation time, whereas the time to return to activities of daily living was significantly shorter in the plate group. No significant between-group differences were observed for range of motion or grip strength at any time point. While radial inclination and length remained statistically similar in both groups up until the 6-month follow-up, palmar inclination significantly decreased in the K-wire group.