HMN 2026: What is the bone healing ‘superpower’ in children

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.”

The CRAFFT trial (Children’s Radius Acute Fracture Fixation Trial) recruited 750 children aged 4–10 from 49 hospitals across the U.K. Participants were randomly assigned to receive either surgical fixation or treatment with a plaster cast.

Patients were measured at regular intervals against a set of criteria. At three months, children who had surgery reported slightly better arm function, but the difference between groups was very small. By six and 12 months, there was no difference in recovery, suggesting that early advantages with surgery do not persist.

There were complications following surgery, including infections, scarring, and nerve irritation. Nonsurgical treatment, which avoids anesthesia and operative intervention, was shown to reduce NHS costs by around £1,600 per patient on average.

The trial was designed with input from families, who helped define what level of improvement would be meaningful enough to warrant surgery. The observed difference between treatments fell below this threshold.

Professor Dan Perry, NIHR Research Professor and Children’s Orthopedic Surgeon at Alder Hey Children’s Hospital and the University of Liverpool, and lead author, said, “It is astonishing that children have the ability to grow broken bones straight again—even if they initially appear a little wonky—it’s a superpower that is unique to children. Putting these results into practice could reduce the number of children exposed to the risks of anesthesia and surgery, and ease pressure on health care services without compromising recovery.”

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