Six randomized controlled trials including elderly patients (≥60 years) with acute displaced distal radius fractures were included in this systematic review and meta-analysis comparing volar locking plate (VLP) fixation versus closed reduction and immobilization. Pooled outcomes of interest included functional scores (DASH, PRWE), grip strength, range of motion, radiographic parameters, and complication rates at a 12-month follow-up. While the surgical group had better radiological outcomes, the functional differences did not reach the minimal clinically important difference. No significant differences were found in complication rates between groups. These findings suggest that VLP fixation does not provide clinically meaningful advantages over conservative treatment in elderly patients with distal radius fractures.