62 patients with unstable distal radial fractures were randomized to undergo either closed reduction and internal fixation with an intramedullary nail (MICRONAIL) or open reduction and internal fixation with a volar locking plate, to compare the functional, clinical and radiographic outcomes associated with these two treatments methods. Results indicated that the intramedullary MICRONAIL system yielded significantly improved functional outcomes and wrist range of motion, when compared to the volar locking plate method early postoperatively (6 weeks post-operation), but not at the 3- and 12-month follow-ups. The two treatment methods yielded similar radiographic outcomes at all time points throughout the study.