Objective: The aim of this study was to evaluate the efficacy of conservative treatment (cast immobilization) for complex intra-articular distal radius fractures (AO type C) in elderly patients and to determine whether or not the application of a volar locking plate (VLP) is necessary. Methods: A retrospective study on patients treated at two different clinics was conducted between 2014 and 2016. A total of 49 elderly patients 60 years old were treated either operatively with volar locking plate fixation (n ¼ 25; 7 males and 18 females; mean age: 66.6 ± 7.4 years) or conservatively with cast immobilisation (n¼ 24; 7 males and 17 females; mean age: 68.9 ± 8.7 years) for complex intra-articular distal fractures. Clinical, functional and radiological evaluations were conducted at the final follow-up examinations of the patients. Results: There was no statistically significant difference between the two groups of patients with respect to the follow-up periods, gender, age and fracture type (p > 0.05). At the end of mean follow-up time of 16 months the grip strength (p ¼ 0.03), radial tilt (p ¼ 0.06), radial inclination (p ¼ 0.01), radial height (p ¼ 0.01) and articular step-off (p ¼ 0.02) were significantly better in the volar locking plate group, while there was no significant difference between the functional results (based on the Quick Disabilities of the Arm, Shoulder and Hand score) (p ¼ 0.8) and range of motion. The grip strength was significantly higher in the VLP group when compared to the cast group (p ¼ 0.03). Conclusion: The results of this study suggest that the locking plate fixation for the complex intraarticular distal radius fractures provides better results for the grip strength and radiographic parameters than cast immobilization in patients >60 years old, while no difference was found between the clinical and functional results.