Ninety patients with acceptably reduced intra-articular distal radius fractures were randomized to receive surgical fixation with a volar plate (n=44) or nonoperative cast immobilization (n=46). The primary outcome was patient reported function at 12 month follow-up utilizing the Patient-Rated Wrist Evaluation (PRWE) score. Secondary outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Short Form-36 (SF-36) questionnaire, pain scores, range of motion, grip strength, radiographic parameters and complications. The operative group had significantly better PRWE and DASH scores at 12 month follow-up. No differences in ROM, grip strength or pain scores existed at 12 month follow-up. No differences existed in overall complications. However, 13 (28%) of the patients in the nonoperative group went on to require operative fixation due to secondary displacement or malunion.