Background: Distal radius fractures are among the most common orthopedic injuries encountered in clinical practice, accounting for a significant proportion of upper limb fractures.The study aims to compare the clinical, radiographic, and functional outcomes of closed reduction and cast application versus percutaneous K-wire fixation in the management of extra-articular fractures of the distal end of the radius.Materials and Methods: This prospective, randomized comparative study was conducted on 120 patients diagnosed with extra-articular distal radius fractures. Patients were randomly allocated into two groups: Group A (n=60): Closed Reduction and Cast Application, and Group B (n=60): Percutaneous K-Wire Fixation. Radiographic outcomes, including volar tilt, radial inclination, and ulnar variance, were assessed at follow-ups. Functional recovery was evaluated using DASH scores and grip strength. Complications, time to fracture union, and return to work were also recorded. Statistical significance was set at p < 0.05.Results: Both groups were comparable in terms of demographic characteristics (p > 0.05). The K-wire fixation group demonstrated superior radiographic outcomes, with significantly improved volar tilt (11.5 ± 1.8° vs. 8.4 ± 2.1°, p < 0.01), radial inclination (23.8 ± 2.9° vs. 21.2 ± 3.4°, p < 0.01), and ulnar variance (0.8 ± 0.3 mm vs. 1.4 ± 0.5 mm, p < 0.01). Functional outcomes also favored K-wire fixation, showing lower DASH scores (18.4 ± 5.3 vs. 32.6 ± 6.8, p < 0.01) and higher grip strength recovery (85.5% ± 7.8% vs. 72.0% ± 9.2%, p < 0.01). The loss of reduction was significantly higher in the cast group (20.0% vs. 6.7%, p = 0.03), while pin tract infections occurred in 10.0% of K-wire cases (p = 0.02). Mean time to fracture union was shorter in the K-wire group (7.2 ± 1.0 vs. 8.5 ± 1.2 weeks, p < 0.01), leading to earlier return to work (8.5 ± 1.6 vs. 10.2 ± 1.8 weeks, p < 0.01).Conclusion: Percutaneous K-wire fixation provides better fracture alignment, improved functional recovery, and faster return to daily activities compared to closed reduction and cast application. While K-wire fixation reduces loss of reduction and need for re-intervention, it carries a higher risk of pin tract infections. Overall, K-wire fixation is a more effective and reliable treatment option for extra-articular distal radius fractures.