Two hundred fifty-eight patients with Colles’ fractures were randomized to ultrasound-guided radial+median nerve blocks (n=127) or hematoma block (n=131). The primary outcome was satisfactory fracture reduction (binary, radiographic criteria, blinded adjudication). Secondary outcomes included need for surgical treatment at ~10-day follow-up, self-reported pain (11-point NRS) at predefined time points, and Emergency department (ED) process time from block to reduction. Overall, the results of the study revealed higher satisfactory reduction with ultrasound blocks and fewer surgeries, with no difference in pain during reduction but lower pain during block placement; ultrasound blocks took longer to reduction. In short, ultrasound-guided median+radial blocks improved initial reduction success and may reduce operative conversions, at the expense of longer ED timelines.