A 5-year-old boy falls off a climbing frame and lands on his wrist. Should you reduce the fracture - or simply put it in a nice cast and let it remodel? Until now, people might have had strong views about this, but no-one really knew. 👇

That is until today when the @CRAFFTStudy was published in @TheLancet. This was a non-inferiority RCT of 750 children (age 4–10) with displaced distal radius fractures randomised to: 👉 fracture reduction 👉 cast alone (no manipulation) Here’s what we found 🧵

What did we actually measure? 👉 Upper limb function at 3 months (using the PROMIS Upper Extremity Score for Children) A patient-centred outcome - focused on function, not X-rays. 👇

The @CRAFFTStudy recruited 750 children. 329 (44%) had completely off-ended fractures - the kind many clinicians might feel must be reduced. This wasn’t a cohort of children with minor injuries. 👇

So what did we find? At 3 months, we did not demonstrate statistical non-inferiority of casting. But the difference was very small and below what families considered meaningful. 👇

And that small early difference didn’t last. By later follow-up, there was no meaningful difference in function between the groups. 👇

What about harms? Reduction was associated with: ⚠️ more complications 💰 higher costs All for a very modest early benefit. 👇

So, what does this mean for practice? For most children with displaced distal radius fractures, a cast-first approach is a good starting point. 👇

@MrDanPerry I treated many with no pain medication, gentle reduction and casting. No complications. Today the anesthesia and lack of skill with plaster of paris might be the cause for complications. Blount was my guide and Campbell Clinic my mentors.