External fixation with or without ancillary K-wire fixation, once being one of the most popular methods of surgery for unstable distal radius fractures, is now losing its position due to a recent surge in the use of volar locking plates. However, these changes are not firmly grounded on scientific evidence. Recent clinical trials showed that a similar wrist function was achieved when the use of external fixation was compared with that of volar locking plates at 1 year after surgery for the treatment of unstable distal radius fractures, even though the rate of functional recovery was slower in the former. In addition, it is still a question whether additional costs and time paid for volar locking plates can be justified by such a small gain in wrist function. We will review recent studies comparing external fixation with volar locking plates regarding wrist function and costs, and discuss current indication of external fixation for unstable distal radius fractures.