92 patients with a complex intra-articular distal radius fracture and undergoing surgical fixation were allocated to either internal fixation with a volar locking plate or management with K-wires and an external fixator. The purpose of this study was to compare fixation methods for functional and radiographic outcomes over the first 12 postoperative months. Results demonstrated better outcome with volar plating for patient-reported function, wrist range of motion, and grip strength in the first 3 to 6 months postoperatively, but no significant differences between volar plating and external fixation for these outcomes at 12 months. The only radiographic difference observed between groups was significantly lower ulnar variance in the volar plating group.