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Objective: To investigate the effect of manual reduction with traditional small splints fixation for distal radius fractures in older patients in the emergency department.Methods: Older patients (aged at least 60 years) with distal radius fractures were enrolled in this study. The patients were randomly divided into the treatment group and the control group. The treatment group was treated with manual reduction and small splints fixation. The control group was treated with manual reduction and resin plaster fixation. Before treatment, after reduction, and 3 months after treatment, the palmar tilt angle, ulnar deviation angle, and radial length were recorded. Before treatment and 3 months after treatment, the Cooney wrist joint scores were recorded. The time of fracture healing and related adverse events during the treatment were recorded. Results: Before treatment and after reduction, there were no statistically significant differences between the two groups in palmar tilt angle, ulnar deviation angle, or radial length (P>0.05). Three months after treatment, the palmar tilt angle, ulnar deviation angle, and radial length of the treatment group were better than those of the control group (P<0.05). The Cooney wrist scores of the treatment group was significantly higher than that of the control group three months after the treatment (P0.05). Conclusions: Compared with resin plaster fixation, traditional small splints fixation for distal radius fractures in older patients have the advantages of less loss of fracture reduction and faster functional recovery. Besides, the method is simple and low cost thus, it needs to be promoted.