A randomized, prospective study was carried out on 32 elderly patients with an unstable intra-articular distal radial fracture (AO-C2 or C3) to compare primary external fixation with plaster immobilization. The radiological outcome in the external fixator group was significant better than in the plasterimmobilization group. In particular, the radiocarpal angle and radial inclination were regained and maintained in the external fixator group. However, the functional results at six weeks, three months, and one year showed no statistically significant differences between the two groups. Only the mean volar flexion at one year was better in the external fixator group. There were three major complications, one persisting reflex symphatetic dystrophy and two Dupuytren contractures, all in the external fixator group. Although external fixation of unstable intra-articular distal radial fractures in elderly patients leads to favourable radiological end-results, external fixation may lead to significant complications; the functional endresults are not superior to those treated with plaster immobilization. The conclusion must be: plaster immobilization and external fixation are of equal merit as treatment modalities in elderly patients with an unstable intra-articular distal radial fracture.