Broken Wrists in Children: Evidence from the CRAFFT Study
Broken wrists are common injuries in children, and the bones often move out of place. In children under 11 years old, there are different ways to treat these injuries because their bones are still growing and can straighten as they heal.
Why didn’t doctors know which treatment was better?
When a child had this type of wrist fracture, doctors usually treated it in one of two ways.
Some doctors put the arm in a plaster cast and let the bone heal naturally. In younger children, bones have a remarkable ability to straighten themselves as they grow - even if the wrist looks a little bent at first.
Other doctors preferred to do surgery. Under a general anaesthetic, the bone was straightened and then held in place with a cast and sometimes metal wires or a plate.
Both treatments were used across the UK, but no one had properly tested which was better. That meant doctors and families could not be sure which option was best. Generally, families wanted to avoid surgery if possible, but only if a plaster cast worked just as well. That is exactly what the CRAFFT study set out to find.
The CRAFFT Study
The CRAFFT Study – short for the Children’s Radius Acute Fracture Fixation Trial – was set up to find out which treatment works best: whether surgery to straighten and fix the broken bone was better than a plaster cast, allowing the bone to straighten naturally as it healed.
The study involved 750 children aged between 4 and 10 years old. Half of the children were given a cast, allowing their broken bone to straighten naturally, whilst the other half had surgery.
The study was a randomised trial, meaning each child had an equal chance of receiving either treatment – ensuring the results were fair and trustworthy.
In the year following the injury, children and families were asked on regular occasions about how well they could use their arm, how much it hurt, and what they thought of the appearance of their arm. They were also asked how much school they missed, how many hospital visits they had attended, and if there were any complications following their injury.
Results
Was surgery better than resting the wrist in a plaster cast?
Toolkit
Turn the CRAFFT findings into everyday practice.