10 randomized controlled trials (RCTs) consisting of 715 patients with 772 distal radius fractures were evaluated to determine whether surgical treatment using external fixation (EF) or internal fixation (IF) provided better outcomes. Results indicated that patients undergoing IF had significantly better Disabilities of the Arm, Shoulder and Hand (DASH) at 12 months compared to the EF group. IF also resulted in superior volar tilt at 12 months, and fewer minor complications compared to EF. Independent analysis of a sub-group of RCTs using volar locking plates indicated a significantly better DASH scores at 3 and 6 months compared to EF, however, this was lost at 12 months. Independent analysis also indicated that volar locking plates provided improved grip strength at 3 months, however this was not maintained at later follow-ups.