The DRIFT trial compared nonoperative treatment with operative treatment with volar locking plating (VLP) in patients aged 65 years and older with dorsally displaced distal radius fractures (DRF) type A or C. The study enrolled 291 patients (mean age 73 years, 258 women), of whom 124 had primary malignant DRF (66 nonoperative, 58 VLP) and 86 early malignant DRF (44 non-operative, 42 VLP). The primary endpoint was patient-reported wrist function (PRWE) at 12 months. In primary malignant DRFs, the mean difference in PRWE was -9.6 points (95% CI [-17.4, -1.7]; p=0.0178) in favor of VLP, which is less than the minimal clinically important difference of 11 points. In early malignant DRF, the difference was -6.2 points (95% CI [-15.4, 3.0]; p=0.1816). Treatment-related adverse events occurred in 25 patients (15% in inoperable primary malignant DRF). The study recommends deciding on treatment after primary reduction, as further radiographic follow-up does not bring benefit.