Closed reduction with external fixation (CREF) and percutaneous pinning (CRPP) are commonly used surgical interventions to treat distal radius fractures. However, there is no consensus regarding the optimal management of these types of fractures. Therefore, this study aimed to compare these treatments' clinical and radiological outcomes in two subgroups of distal radius fractures. The patients who were ≥ 18 and were referred for the diagnosis of type I and III (Fernandez) distal radius fractures were treated with one of these two methods, which have been evaluated through a retrospective analysis of the medical records. A total of 244 patients were divided into CREF treatment (n = 122) and control treatment (n = 122). These patients' radiological, clinical, functional, and incidence rates of complications (over-distraction, radial neuropathy, and deep or superficial infection) were compared to analyze each method's positive and negative aspects. This study showed that patients in the PP group reported significantly less pain than those in the EF group (P-value < 0.05). The PP group scored lower in the specific and general activities categories, significantly reducing Patient-Rated Wrist Evaluation (PRWE). Although the CREF group had greater radius shortening, the difference was not statistically significant. Notably, the CREF group exhibited a significantly higher incidence of complications. Percutaneous pinning proved to be a more effective method for treating distal radius type I and III fractures. Compared to those treated with external fixation, patients experienced fewer post-treatment complications, lower pain levels, and less difficulty in daily activities.