006 - Operate or Not? Paediatric Medial Epicondyle Fractures (SCIENCE)

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 "Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study)" published in The Lancet. The clinical question: for a displaced medial epicondyle elbow fracture in a child, does surgical fixation deliver better function than non-operative care? Surgery was not shown to be superior, making non-operative care a reasonable option for most. 📄 Citation: Perry DC, Achten J, Zimmermann A, et al. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre, randomised controlled, superiority trial and economic evaluation. Lancet. 2026;407:577–86. DOI: https://doi.org/10.1016/S0140-6736(25)02098-7 Key Takeaways: * Pragmatic multicentre superiority RCT (n=334) with a pre-specified, family-set MCID and a within-trial economic evaluation. * Surgical fixation did not produce a clinically important improvement in arm function over non-operative care. * Because the MCID was pre-specified and powered to, this reads as a genuine "no meaningful benefit" rather than an ambiguous null. * Practice implication: non-operative management is a defensible default for most displaced medial epicondyle fractures. * Outcomes were family-reported and unmasked, with slightly more missing data in the cast arm; the result agrees with a smaller Finnish RCT. 🔗 Full paper: https://doi.org/10.1016/S0140-6736(25)02098-7 Keywords: paediatric elbow fracture, medial epicondyle fracture, SCIENCE trial, surgery versus conservative, children's orthopaedic trauma. New episodes every Sunday. Subscribe so you never miss one.