Introduction Distal radial fractures account for a significant proportion of upper limb fractures, especially in the elderly population with osteoporosis. These fractures can be treated using either surgical or non-surgical methods, with external fixation and conservative treatment being two widely used approaches. External fixation offers immediate stability and allows early mobilization, whereas conservative treatment, including casting, is often recommended for patients with lower functional demands or contraindications for surgery. This study aims to compare the effectiveness of external fixations and conservative treatment in terms of functional outcomes, complication rates, and radiological parameters.  Materials and Methods A retrospective cohort study was conducted on patients diagnosed with distal radial comminuted fractures. Patients were divided into two groups: those treated with external fixation and those managed conservatively with casting. This was a single-center retrospective cohort study analyzing patient records from hospital databases. Ethical approval was obtained from the institutional review board, and patient consent was waived due to the retrospective nature of the study. Data were collected from electronic medical records, radiographic archives, and follow-up reports. Results The study included 150 patients, with 75 in each group. Patients treated with external fixation have a lower DASH Score (15.4) compared to those receiving conservative treatment (21.7), suggesting better functional outcomes and fewer symptoms in the external fixation group. The standard deviations (± 3.2 and ± 4.8) indicate variability in the data. If the difference between the two groups is statistically significant (which would require further statistical testing), external fixation may be considered superior for improving functional outcomes at 6 months. External fixation shows a marginally higher rate of radiological union (92%) compared to conservative treatment (88%) at 6 months. The difference in union rates (4%) is relatively small.  Conclusion External fixation offers better anatomical and functional outcomes for distal radial comminuted fractures compared to conservative treatment. However, the increased complication rate necessitates careful patient selection. Conservative treatment remains an acceptable approach for patients with lower functional demands.