Seventy-two patients with distal radius fractures were randomized to receive 6 weeks of immobilization with a below-elbow cast (n=40) or an above-elbow cast (n=32). The outcomes of interest included radial tilt, volar tilt, ulnar variance, and the incidence of adverse events. A sub-group analysis by the level of instability of the fracture was conducted which was assessed using the LaFontaine criteria. Outcomes were assessed at 1, 3, and 6 weeks follow-up. The results of this study showed no statistical significant differences in the change from baseline in volar tilt (p=0.89), radial tilt (p=0.08), or ulnar variance (p=0.19) between the below-elbow and above-elbow cast groups. In fact, in the subgroup analysis by fracture instability (2 LaFontaine criteria met; 3 or more LaFontaine criteria met), radial tilt loss was statistically significantly greater in the above-cast group compared to the below-cast group (p=0.02, p=0.003; respectively). No major complications were observed in either group.