Two randomized controlled trials and 6 cohort studies (n=858) evaluating the differences between operative and nonoperative treatment of a distal radius fracture in elderly patients were included in this meta-analysis and systematic review. The study was conducted in order to compare the clinical and radiographic outcomes of either external fixation or open reduction and internal fixation as compared to closed reduction and cast immobilization. Comparable pain, function, range of motion, and risk of minor complications was noted between operative and nonoperative managment strategies, while pooled results demonstrated significantly favourable grip strength and radiographic outcomes following operative management versus nonoperative management. However, a significantly greater risk of major complication was also noted among operatively treated groups.