Objective To compare the clinical efficacy and medical costs of reusable moldable splints versus single use splints in manual reduction of distal radius Colles fractures. Methods A total of 120 patients with distal radius Colles fractures admitted between Jan. 2022 and Jun. 2024 were retrospectively enrolled and divided into observation group (n＝60) or control group (n＝60). The observation group underwent fixation with reusable moldable splints, whereas the control group received single use splints. Visual analogue scale (VAS) scores of pain at predefined time points after fixation, as well as time to resolution of swelling, time to clinical fracture union, wrist function assessed by the modified Mayo wrist score, complication rates and direct medical costs were recorded and compared between the 2 groups. Results VAS scores of pain at days 3, 7 and 14 after fixation were significantly lower in the observation group than in the control group (5.00±0.94 vs 5.54±0.76, 3.59±1.00 vs 4.33±0.99, 2.06±1.04 vs 2.79±1.14; all P＜0.05). The observation group also had shorter time to swelling resolution and fracture union (［9.69±1.82］ d vs ［11.99±1.89］ d, ［55.46±4.98］ d vs ［60.28±5.18］ d), a higher rate of excellent or good functional recovery according to the modified Mayo score (73.33% ［44/60］ vs 38.33% ［23/60］), a lower complication rate (28.33% ［17/60］ vs 53.33% ［32/60］), and a lower total direct medical cost over the course of treatment (1 865 ［1 428, 2 186］ yuan vs 2 764 ［2 258, 2 985］ yuan); all differences were statistically significant (all P＜0.05). Conclusion In the manual reduction and fixation of distal radius Colles fractures, reusable moldable splints demonstrate superior clinical efficacy compared with single use splints. They provide more effective pain relief, accelerate swelling resolution and fracture healing, improve functional recovery, and reduce complication rate and overall medical costs.