BACKGROUND: For fracture of distal radius in adults, choosing casting external or open reduction and internal fixation (ORIF) with plates remains controversial. OBJECTIVE: To analyze the results of closed reduction and casting versus ORIF with plates in treatment of fracture of distal radius in adults. METHODS: Databases of PubMed, EMbase, The Cochrane Library (Issue 11, 2017), OVID, Web of Science, CNKI and WanFang were searched. The randomized controlled trials about casting and plate for the fracture of distal radius published before March 2018 were collected. The literature screening was conducted by two researchers independently based on the incision and exclusion criteria, followed by data extraction and bias evaluation. Meta-analysis was performed on RevManager 5.3 software. RESULTS AND CONCLUSION: (1) Fifteen randomized controlled trials were included involving 1 545 patients. (2) Meta-analysis results showed that there were no significant differences in the Disabilities of the Arm, Shoulder and Hand scores (MD=1.83, 95%CI (-0.06, 3.72), P=0.06), Patient-Rated Wrist Evaluation Questionnaire scores (MD=4.01, 95%CI (-4.96, 12.99), P=0.38), range of motion of the wrist joint in dorsiflexion and ulnar deviation (MD=-7.47, 95%CI (-15.40, 0.47), P=0.07; MD=-5.45, 95%CI (-13.82, 2.93), P=0.20) between two groups. The plate groups had a higher Gartland and Werley category (OR=0.52, 95%CI (0.30, 0.90), P=0.02) and grip strength (MD=-10.01, 95%CI (-17.04,-2.99), P=0.005). (3) In the plate group, the incidence of tendinitis (RR=0.10, 95%CI (0.02, 0.51), P=0.006), carpal tunnel syndrome (RR=3.20, 95%CI (1.14, 8.96), P=0.03) and finger stiffness (RR=9.29, 95%CI (1.80, 47.79), P=0.008) were significantly increased. (4) To conclude, for adult patients with fracture of distal, the long-term function between casting and plate is similar. Although the radiological parameters of closed reduction and casting are poor, it does not reduce the range of motion of the wrist joint, nor increase the rate of reoperation, which is firstly chosen for older adults. [ABSTRACT FROM AUTHOR]