9 publications (10 studies) were identified in this meta-analysis comparing external fixation and open reduction with internal fixation (ORIF) using plates for the treatment of distal radius fractures. Meta-analysis of the identified randomized trials demonstrated that ORIF led to significantly lower Disability of the Arm and Shoulder (DASH) scores than external fixation. Additionally, ORIF appeared to be superior to external fixation with regards to ulnar variance and infection rates. The two groups did not differ with respect to range of motion, grip strength, complications and re-operation rate.