Abstract
Distal radius fractures (DRFs) are among the most common upper extremity fractures encountered in clinical practice. Closed reduction followed by external immobilization remains a fundamental treatment approach; however, the procedure is highly operator-dependent and lacks standardization. This article presents a step-by-step protocol for manual reduction and four-splint immobilization using volar, dorsal, radial, and ulnar splints for acute DRFs. The protocol encompasses patient selection, anesthesia administration, patient positioning, sustained longitudinal traction with countertraction, restoration of radial length, correction of dorsal or volar translation and angulation, controlled adjustment of wrist position and forearm rotation, and secure four-splint immobilization. A representative case of a 53-year-old woman with a dorsally displaced fracture of the left distal radius is presented. Pre-reduction radiographs showed a volar tilt of approximately -15°, a radial inclination of approximately 1.74°. Immediate post-reduction radiographs showed a volar tilt of 11.4° and a radial inclination of 17.7°. Follow-up radiographs obtained 6 and 15 days after reduction showed volar tilts of 11.7° and 11.4° and radial inclinations of 15.8° and 15.2°, respectively. This article provides a structured visual protocol describing the direction and sequence of reduction forces and the application of four-splint immobilization. The representative case illustrates procedural feasibility and short-term maintenance of alignment; however, it does not establish comparative effectiveness, safety, superiority, or generalizability. These outcomes require evaluation in larger prospective studies.