Broken wrists are among the most common injuries in children, accounting for about half of children’s fractures. Severely displaced distal radial fractures, where the bones move out of place, are often routinely treated with surgery. However—unlike adults—children have a remarkable ability to straighten broken bones, in a process called remodeling. Researchers questioned whether a plaster cast would achieve the same long-term result without exposing children to the risks of an operation.

In a major U.K. trial led by researchers at the University of Oxford, they found that most children with a severely broken wrist can be treated without surgery. The findings, published in The Lancet, suggest that a nonsurgical, cast-first approach delivers similar long-term recovery while reducing the risks associated with surgery and costs.

Professor Matt Costa, senior author and Professor, Orthopedics Trauma Surgery at the Kadoorie Institute, University of Oxford, said, “These fractures can look very severe on an X-ray, which has traditionally led to surgery to straighten the bone. But because children’s bones are still growing, they have a remarkable capacity to heal. Until now, there has been limited high-quality evidence on whether surgery was always necessary.”