44 patients with an displaced, extraarticular distal radius fracture were randomized to fixation through either open reduction and internal fixation (ORIF) with a volar plate, or to closed reduction and percutaneous pinning (CRPP). The purpose of the current study was to compare direct hospital costs and establish cost ratio during the perioperative period, after 90 days of follow-up, and after 1 year of follow-up. During the perioperative period, cost ratio was 2/7:1 of ORIF to CRPP. At 90 days and 1 year, cost ratios were reduced relative to that during the peroperative period, but remained statistically significant, with higher costs incurred within the ORIF compared to the CRPP group.