461 patients with a dorsally displaced distal radius fracture were randomized to receive either a volar locking plate or Kirschner wire (K-wire) fixation. The purpose of this study was to compare health system and societal costs associated with each method relative to efficacy [measured via quality-adjusted life years (QALYs)], in order to assess cost-effectiveness. Results indicated that there was minimal difference in QALYs between groups, but a significantly greater cost associated with volar locking plates. The incremental cost-effectiveness ratio of volar locking plates fell beyond the societal willingness to pay threshold, and thus volar locking plates are not considered to be cost-effective relative to K-wires in treating distal radial fractures, with K-wires considered to be the cost-saving approach. The original trial that reports on further outcomes was published in BMJ and is also featured on OrthoEvidence, report 6859.