114 patients with unstable distal radius fractures were randomized to undergo either external fixation (EF) with adjuvant pins, or volar locking plate (VLP) fixation. The purpose of the study was to compare clinical and radiographic outcomes between VLP fixation and EF fixation. In the primary analysis, no significant differences were observed between fixation methods in patient-reported outcome measures, range of motion (with the exception of radial deviation and supination), grip strength and radiographic outcomes. Subgroup analysis based on fracture type suggested possible benefit of VLP fixation for more complex fracture (AO/OTA type C2 and C3) though further studies powered for analyses specifically within fracture types is necessary further evaluate fixation methods for distal radius fractures.