University of Liverpool and Oxford Study Finds Non Surgical Treatment Effective for Children’s Severe Wrist Fractures

University of Liverpool and Oxford Study Finds Non Surgical Treatment Effective for Children’s Severe Wrist Fractures

(IN BRIEF) A large UK clinical trial involving the University of Liverpool and the University of Oxford has found that most children with severely broken wrists can be successfully treated without surgery. The CRAFFT trial showed that while surgery may offer a slight short-term improvement, long-term recovery outcomes at six and twelve months are the same as those achieved with a simple plaster cast. Non-surgical treatment also avoids complications such as infections and nerve damage, eliminates the need for anaesthesia, and reduces healthcare costs significantly. The findings highlight children’s natural ability to realign bones during growth and support a shift toward a cast-first approach as standard practice. Published in The Lancet, the study provides strong evidence to reduce unnecessary surgical interventions while maintaining high-quality patient outcomes.

(PRESS RELEASE) LIVERPOOL, 17-Apr-2026 — /EuropaWire/ — University of Liverpool has contributed to a major UK-wide clinical trial demonstrating that many children with severely broken wrists can recover effectively without undergoing surgery. The findings highlight that a non-surgical, cast-first approach can achieve comparable long-term outcomes while avoiding surgical risks and reducing healthcare costs.

The study was led by Professor Dan Perry, NIHR Research Professor and paediatric orthopaedic surgeon at Alder Hey Children’s NHS Foundation Trust and the University of Liverpool, in collaboration with researchers from the University of Oxford. It focused on distal radial fractures—one of the most common injuries in children, accounting for approximately half of all childhood fractures.

Traditionally, severely displaced fractures, where bones are significantly out of alignment, have often been treated with surgical intervention. However, children possess a unique biological advantage: their bones can naturally realign during growth through a process known as remodelling. This prompted researchers to investigate whether immobilisation with a plaster cast alone could deliver similar long-term recovery outcomes.

Professor Matt Costa, senior author of the study and Professor of Orthopaedic Trauma Surgery at the Kadoorie Institute, University of Oxford, noted that although such fractures can appear severe on X-rays, children’s ongoing bone development allows for significant natural correction. Until now, however, there has been limited high-quality evidence to determine whether surgery is always necessary.

The CRAFFT trial (Children’s Radius Acute Fracture Fixation Trial), funded by the National Institute for Health and Care Research, enrolled 750 children aged between 4 and 10 across 49 hospitals in the UK. Participants were randomly assigned to either surgical fixation or treatment with a plaster cast and were monitored over time using standardized recovery measures.

Initial results showed that children who underwent surgery experienced slightly improved arm function at the three-month mark, but the difference was minimal. By six and twelve months, recovery outcomes were equivalent between the two groups, indicating that the early advantages of surgery do not persist over time.

The study also identified complications associated with surgical treatment, including infections, scarring, and nerve irritation. In contrast, non-surgical management avoided these risks and reduced the need for anaesthesia. Additionally, the cast-first approach was associated with cost savings of approximately £1,600 per patient, easing financial pressures on healthcare systems.

Importantly, the trial incorporated input from families to determine what level of improvement would justify surgical intervention. The differences observed between treatment approaches fell below this threshold, reinforcing the case for non-surgical management in most cases.

Professor Perry emphasized that children’s ability to naturally correct bone alignment is a remarkable characteristic, describing it as a unique “superpower.” He suggested that adopting these findings in clinical practice could reduce unnecessary surgical procedures while maintaining excellent recovery outcomes and alleviating strain on healthcare services.

The results, published in The Lancet, support broader adoption of non-surgical treatment as the standard approach for most children with these types of fractures.

Media Contact:

Joanne Carr
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E: jocarr@liverpool.ac.uk

SOURCE: University of Liverpool