111 patients with unstable distal radius fractures and undergoing surgery were randomized to volar locked plating (VLP) or external fixation (EF) with pins. The purpose of this study was to compare the efficacy of each treatment over 5-year follow-up. Outcome measures included wrist function, pain, and range of motion. Results revealed largely similar outcome between groups, with the only significant between-group difference in forearm supination, which was significantly greater in the VLP group. During the follow-up period, 12 patients (23%) in the volar locking plate group required plate removal due to plate-related complications.