This meta-analysis evaluates reported outcomes of volar locking plates versus external fixation for management of distal radius fractures. A comprehensive literature search was carried out using PubMed, embase, MEDLINE, and the Cochrane Library. Multiple outcomes were analysed: study characteristics, objective/subjective outcome measures, radiographic parameters, and complication rates. Nine studies containing 780 participants met the outlined inclusion criteria. Disabilities of the arm, shoulder, and hand scores significantly favoured volar locking plates, but only at 3 months was the difference clinically meaningful. Grip strength, extension, and supination were better in the volar locking plates group in the early post-operative period, but were similar at 12 months. Ulnar variance was better restored by volar locking plates. The volar locking plates group was associated with higher re-operation rate, and the external fixation group had a higher infection rate. Current literature suggests that volar locking plates can provide better subjective scores and radiographic parameters, especially in the first 3 months, but may be associated with a higher re-operation rate.
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