Twelve studies containing 1205 patients with unstable distal radius fracture were included in this meta-analysis comparing external fixation (n=613) to volar locking plate fixation (n=592). Pooled outcomes of interest included pain scores on a visual analog scale (VAS), Disability of the Arm, Shoulder and Hand (DASH) scores, range of motion, radiological outcomes, and the incidence of adverse events. Meta-analysis results demonstrated significantly favourable pooled VAS pain scores at 3 months, and favourable DASH scores at 3, 6 and 12 months, in the volar locking plate group compared to the external fixation group (p<0.05 for all). Also, the risk of minor complications (p=0.03) and overall complications (p=0.0003) were significantly lower in the volar locking plate group. Pooled flexion, extension, and supination range of motion at 3 months, as well as flexion range of motion at 6 months, were significantly greater in the volar locking plate group (p<0.05 for all). No significant differences in pooled radiological outcomes were observed between the two groups (p>0.05 for all).