Objective To compare the efficacy of percutaneous double external fixators (EF) and EF combined with volar locking plate (VLP) in the treatment of AO C1, C2 and C3 type distal radius fracture (DRF). Methods The data of 108 patients with AO C-type DRF from 2019 to 2022 were reviewed. Fifty-one patients were treated with double EF (a no-bridging cemented-pin frame and a conventional wrist-bridging EF) and 57 patients were treated with EF (a conventional wrist-bridging EF) combined with VLP. The imaging parameters (palmar tilt, radial inclination, radial height, ulnar variance, etc.), wrist motion and grip strength were measured. Wrist pain intensity was evaluated by visual analogue scale (VAS). The whole function of the upper limb was assessed by disability of arm shoulder and hand scale (DASH), the wrist function was evaluated by Mayo wrist score (MWS), and the patient satisfaction was evaluated by short assessment of patient satisfaction (SAPS). The incidence of complications was evaluated according to the patient’s chief complaint and the surgeon’s comprehensive judgement. Results There were no significant differences in age, gender, injury cause, AO types or operation time between the 2 groups (all P＞0.05). The time from injury to operation, intraoperative blood loss and hospital stay in the double EF group were superior to those in the EF combined with VLP group (all P＜0.001). The patients were followed up for 24 to 33 months. There were no significant differences in palmar tilt, radial inclination, radial height or ulnar variance at the last follow-up (all P＞0.05); the VAS score (P＝0.025) and SAPS score (P＝0.015) in the double EF group were significantly better than those in the EF combined with VLP group. There were no significant differences in the range of motion (flexion, extension, radial deviation, ulnar deviation, pronation or supination), grip strength, MWS or DASH scores between the 2 groups (all P＞0.05). The overall complication rate of the double EF group was 13.73% (7/51), which was lower than that of the EF combined with VLP group (28.07%) (16/57) (P＜0.05). Conclusion Percutaneous double EF is easy to operate and relatively safe, with few complications and satisfactory follow-up results. It can be a treatment option for OA C-type DRF.