Objective: In the treatment of unstable fractures of the distal radius, there is no conclusive evidence about the greater effectiveness of the reduction and fixation methods: bloodless external fixation (BEF) or open locked volar plate (LVP). The goal is to determine which of the two methods is most effective. Methods: Eighty patients were enrolled in this randomized clinical trial. The primary endpoint was the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Scale [VAS]). The final assessment was given at 12 months postoperatively. Results: In the final evaluation, there was no difference between groups in assessments of the DASH questionnaire (3.71 for the LVP group and 2.72 for the BEF group, P = .58), and pain by VAS (0.84 for the LVP group and 0.53 for the BEF group, P = .39). Treatment with LVP was more effective than one with BEF in early evaluation with 8 weeks to DASH questionnaire (21.82 for the LVP group and 39.88 for the BEF group, P = .0012). In the group treated with LVP, there were 11.7% of complications, and in the group treated with external fixator, 26.3%. There were 3 treatment failures in the group treated with LVP and none in the other group. Conclusions: There were no assessed differences between groups in the final evaluations of the DASH questionnaire and the pain by VAS. In the early 8-week assessment, there was a positive difference to the LVP method.
