73 elderly patients with displaced unstable distal radial fractures were randomized to receive either open reduction and internal fixation (ORIF) with a volar locking plate or cast immobilization. The results from 12 month follow-up indicated that patients who received ORIF displayed no significant differences in comparison to cast immobilization on the basis of pain, range of motion, patient satisfaction, and disability. However, it was found that patients who received ORIF had a significantly higher complication rate in comparison to patients who received cast immobilization.