The results of treatment for distal radial fractures of types Older 3 with more than 5 mm shortening and Older 4 were studied in a prospective randomized series of 41 patients with regular follow-up to six months after operation. The patients were treated with closed reduction under anaesthesia and either external fixation ad modum Hoffman or percutanous pinning and a plaster cast for six weeks. Both treatment groups achieved a clinically and radiologically good result without any significant difference. There were no infections, and except for one patient with persistent signs of mild reflex dystrophy we experienced no serious complications. Owing to simplicity and treatment costs we generally prefer treatment by pinning and plaster cast.