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
8 hours ago
- #Paediatric fractures
- #Health economics
- #Non-inferiority trial
- The CRAFFT study was a randomized trial comparing non-surgical casting with surgical reduction for children aged 4-10 with severely displaced distal radial fractures.
- At 3 months, surgical reduction showed slightly better upper limb function (mean score 46.6 vs. 44.9), but the difference did not meet the non-inferiority margin set at -2.5 points.
- In children with completely off-ended fractures, non-surgical casting was non-inferior against a wider margin of -5 points.
- Surgical reduction had more complications like wound infections and scarring within 8 weeks, while refractures were more common after casting.
- Non-surgical casting was significantly cheaper by £1665 per patient and had a high probability of being cost-effective despite a small reduction in quality-adjusted life-years.
- The trial concluded that while surgical reduction offered a modest short-term functional advantage, it was not cost-effective, and a cast-first strategy is supportable for most children.