Unstable distal radius fractures can be treated with external fixation or internal fixation using a volar locking plate. In this randomized controlled study, patients with dorsally displaced fractures were assigned to either strategy and followed with functional, radiographic and complication outcomes. The two treatments produced broadly similar longer-term disability scores, but volar plating offered advantages in restoration of alignment and some early functional domains. This reflects an important principle in distal radius surgery: radiographic correction, early wrist motion and long-term patient-reported function do not always move in parallel. For many patients, a volar plate permits more predictable early mobilisation because the construct provides stable internal fixation and avoids an external frame. However, the operation also introduces its own risks, including tendon irritation and hardware-related issues. The evidence supports volar locking plates as a strong option for selected unstable fractures, especially when early functional recovery is a priority. It does not establish a need for surgery in every distal radius fracture. Patient age, activity level, fracture pattern, bone quality and functional demands should continue to guide treatment. The study is a useful reminder that “better alignment” and “better patient outcome” are related but not synonymous endpoints.