SGEM#510: Take this Broken Radius and just Cast It.

Severely displaced distal radius fractures in children aged 4 to 10 years can often be managed with a cast-first strategy rather than surgical reduction. The CRAFFT study, published in The Lancet, demonstrates that while surgery provides a small, early functional advantage, this difference disappears by 6 to 12 months, rendering the two approaches functionally equivalent in the long term. Non-surgical casting avoids the risks of anesthesia, procedural pain, and potential complications associated with surgery, while also proving more cost-effective. Emergency physician and educator Dr. Andy Tagg emphasizes that clinical success should be measured by patient-oriented outcomes like function and quality of life rather than radiographic alignment. This shift challenges the traditional reliance on surgical intervention for visually alarming but biologically stable pediatric fractures, encouraging a more conservative, evidence-based approach at the bedside.