90 patients with distal radius fractures and accompanying basal ulnar styloid fractures with stable distal radioulnar joints were randomized to receive surgical fixation of the ulnar styloid fracture (n=45) or no surgical fixation (n=45). The primary outcome of interest was the Disability of the Arm, Shoulder and Hand (DASH) score. Secondary outcomes of interest included Modified Mayo Wrist Scores (MMWS), pain on a Visual Analog Scale (VAS), grip strength, wrist range of motion, and complications. No significant differences were observed between the two groups in DASH scores, MMWS scores, grip strength, or range of motion. However, the rate of complications was higher in the fixation group. The rate of non-union was higher in the no fixation group. The results of this study suggest that surgical fixation of associated basal ulnar styloid fractures may not be required after distal radius fractures when the distal radioulnar joint is stable, but could improve ulnar styloid fracture union rate.