201 patients with dorsally displaced distal radial fractures were included in this trial to compare the outcomes of three different surgical fixation methods. Patients were randomized to closed reduction and percutaneous pinning (CRPP), non-spanning external fixation (NSEF), or open reduction and internal fixation with a volar locking plate (ORIF). Functional outcomes were measured over a 1 year follow-up period. At 1-year follow-up, all three groups demonstrated significant improvements in functional outcomes, with no significant differences between groups. The results of this trial suggest that the choice of the operative procedure used in this patient population should be based on cost, as functional outcomes appear to be similar.