Five randomized controlled trials (RCTs) were included in this systematic review and meta-analysis comparing clinical, functional, and radiographic outcomes between volar locking plates (VLP) and intramedullary nails (IMN) in the management of distal radius fractures. Additionally, the incidence of postoperative development of carpal tunnel syndrome was compared between techniques. No significant differences in pooled Disabilities of the Arm, Shoulder, and Hand scores or Gartland-Werley scores, range of motion in any direction, or radiographic variables. There was a significantly lower incidence of postoperative carpal tunnel syndrome development observed with intramedullary nails versus volar locking plates.