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 evaluation.

Questo studio è stato identificato come potenzialmente ad alto impatto. La metrica High Impact di OE, guidata dall'AI, stima l'influenza che un articolo potrebbe avere integrando i segnali della rivista in cui è stato pubblicato e il contenuto scientifico dell'articolo stesso. Sviluppato utilizzando un'elaborazione del linguaggio naturale all'avanguardia, il modello High Impact di OE prevede in modo più accurato la futura performance citazionale di uno studio rispetto al solo fattore di impatto della rivista. Ciò consente di riconoscere prima le ricerche clinicamente significative e aiuta i lettori a concentrarsi sugli articoli che hanno maggiori probabilità di influenzare la pratica futura.

Riassunto dello studio

750 children aged 4–10 years with severely displaced distal radial fractures were randomized to receive non-surgical casting or surgical reduction. The primary outcome of interest was upper limb function at 3 months, measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Score for Children. Secondary outcomes included pain, health-related quality of life, cosmetic appearance, complications, unplanned surgery, and health-care costs. Outcomes were assessed at 6 weeks and 3, 6, and 12 months. Overall, the results revealed that surgical reduction provided a small improvement in upper limb function at 3 months, and non-inferiority of casting was not established against the prespecified margin. However, functional differences were no longer evident at 6 or 12 months, while casting was associated with fewer early complications and substantially lower costs. These findings suggested that non-surgical casting could be considered as an initial treatment strategy for most children with severely displaced distal radial fractures.