002 - Cast or Operate? Paediatric Wrist Fractures (CRAFFT)

Got something to say to this podcast? Send a voicemail, and you might hear yourself on the next episode! In this episode of Ortho Appraised, Dr Rajabifard appraises "Non-surgical casting versus surgical reduction for children with severely displaced distal radial fractures (the CRAFFT Study)" published in The Lancet. The clinical question: in children with a badly displaced distal radius fracture, is a cast alone — no manipulation — as good as surgical reduction? The findings support offering a cast first for most children. 📄 Citation: Perry DC, Zimmermann A, Achten J, et al. Non-surgical casting versus surgical reduction for children with severely displaced distal radial fractures (the CRAFFT Study): a multicentre, randomised, controlled non-inferiority trial and economic evaluation. Lancet. 2026;407:1538–48. DOI: https://doi.org/10.1016/S0140-6736(26)00409-5 Key Takeaways: * Well-conducted multicentre non-inferiority RCT — 750 children across 49 UK hospitals, with modern mixed-model missing-data handling. * Function at 3 months only trivially favoured surgery (ITT −1.64; per-protocol −2.07 on PROMIS), and the arms were level by 6 months. * Formally, non-inferiority of casting was "not demonstrated" against the −2.5 margin — but the difference is clinically negligible. * Practice implication: a cast without manipulation is a reasonable first-line choice for most, sparing anaesthetic and theatre time. * Outcomes are parent-reported and, unavoidably, unmasked; the completely off-ended subgroup is where casting is least certain. 🔗 Full paper: https://doi.org/10.1016/S0140-6736(26)00409-5 Keywords: paediatric distal radius fracture, CRAFFT trial, cast versus surgery, children's wrist fracture, non-inferiority RCT. New episodes every Sunday. Subscribe so you never miss one.