Background <p>Distal radial physeal fractures are the most common type of physeal fracture. However, few studies have been dedicated to the role of ultrasound-guided closed reduction in these fractures. This study aimed to investigate the utility of ultrasound-guided closed reduction in paediatric distal radial physeal fractures.</p> Methods <p>Consecutive patients undergoing ultrasound-guided closed reduction of fractures in our department between November 2017 and October 2019 were included. The adequacy of realignment according to the ultrasound and radiography was recorded.</p> Results <p>A total of 51 patients were included in the study. Closed reduction was successfully achieved in all cases who underwent ultrasound-guided cases. The sensitivity for confirming successful anatomical manipulation with ultrasound was 95.3% (95% CI: 82.9 ~ 99.2%), while the specificity was 87.5% (95% CI: 46.7 ~ 99.3%). The positive predictive value (PPV) was 97.6% (95% CI: 85.9 ~ 99.9%), and the negative predictive value (NPV) was 77.8% (95% CI: 40.2 ~ 96.1%). The corresponding positive and negative likelihood ratios were 7.63 (95% CI: 1.22 ~ 47.77) and 0.05 (95% CI: 0.01 ~ 0.21). There was a high level of agreement between ultrasound and radiographs assessments of anatomical reduction [κ: 0.788 (± 0.117)]. Redisplacement occurred in three cases (5.9%) based on radiographic assessment with one case being a Salter-Harris type I injury and two cases being a Salter-Harris type II injury. At the final follow-up, all fractures had healed, resulting in excellent cosmesis without any other complications.</p> Conclusions <p>Our data suggest that ultrasound-guided closed reduction can be considered an excellent alternative method for the treatment of distal radial physeal fractures.</p>