80 patients with a displaced distal radius fracture were randomized to primary treatment through either palmar plate fixation or cast immobilization. Patients were assessed over 2-year follow-up, which included patient-reported disability (Disabilities of the Arm, Shoulder, and Hand [DASH]), wrist range of motion, grip strength, adverse events, and cases of secondary surgery. A total of 18/42 patients assigned to cast immobilization demonstrated loss of fracture reduction; 16 of these patients underwent secondary palmar plating. At 2 years, DASH score was significantly lower in the palmar plate group compared to the cast immobilization group. In subgroup analysis, the significant difference between groups when considering patients <65 years of age, but not in patients 65 years of age or older. Significant differences between groups at 2 years were also observed in range of flexion and range of ulnar deviation.