Objective: To compare the effect of open reduction and plate fixation and closed reduction and external fixation in the treatment of unstable distal radius fractures. Methods: A total of 88 patients with unstable distal radius fractures from January 2015 to March 2020 were retrospectively analyzed and divided into an observation group and a control group according to the time sequence. The control group was treated with open reduction and plate internal fixation, and the observation group was treated with closed reduction and external fixation. Results: The operation time, activity time, and hospitalization time of the observation group were significantly shorter than those of the control group (P<0.05), the intraoperative blood loss was significantly lower than that of the control group (P<0.05), and the American Spinal Injury Association (ASIA) score was significantly higher than that of the control group (P<0.05). The step of articular surface in the observation group was (1.45±0.56) mm, ulnar deviation was (24.86±2.14)° and volar inclination was (13.32±1.74)°, both higher than the control group, and the difference was statistically significant (P<0.05). There was no significant difference in VAS score and grip strength between the 2 groups before the operation (P>0.05), but there was significant difference between the 2 groups after the operation (P<0.05). The excellent and good rate of the observation group was 88.7% which was higher than that of the control group (84.1%), and the difference was statistically significant (P<0.05). Conclusion: Open reduction and plate fixation can promote the recovery of joint step, ulnar deviation angle, and palmar inclination angle. The short-term curative effect is relatively accurate, but the long-term curative effect is more obvious. In the implementation of the application, the best treatment should be chosed according to the patient’s economic situation.