BACKGROUND: In recent years, there has been an increasing trend in the use of wrist arthroscopy to facilitate the treatment of distal radius fractures using open reduction and internal fixation (ORIF). However, there is no consensus on its superiority despite some previous studies comparing these 2 surgical techniques. Hence, this study sought to conduct a systematic comparison of the effectiveness and safety of arthroscopic-assisted open reduction and internal fixation (AAORIF) and fluoroscopic-assisted open reduction and internal fixation (FAORIF) in the management of distal radius fractures. METHODS: A comprehensive search was conducted in multiple databases to acquire all literature published until January 31st, 2024, comparing AAORIF versus FAORIF for the treatment of distal radius fracture, without any language or publication status restrictions. The Cochrane Collaboration's RevMan 5.4 software was used to perform a meta-analysis. RESULTS: Five randomized controlled trials (169 patients in the AAORIF group and 171 patients in the FAORIF group) suggested that patients with distal radius fracture treated with AAORIF had better disability of arm, shoulder, and hand scores, visual analog scale score, and wrist extension than those treated with FAORIF. However, no significant differences were observed in terms of wrist flexion, pronation, supination, operative time, and complication outcomes between the 2 groups. CONCLUSION: Despite the lack of significant differences in wrist flexion, pronation, supination, operative time, and complication outcomes between the 2 groups, the AAORIF group had more obvious advantages in terms of disability of arm, shoulder, and hand scores, visual analog scale score, and wrist extension based on the above results. We believe that treatment of distal radius fracture with AAORIF may be an optimal option compared with FAORIF. Absolutely, and additional high-quality studies with larger sample sizes are necessary to establish stronger evidence regarding this subject.