Researchers at the Universities of Liverpool and Oxford have concluded that surgery offers no clinical benefit for a common elbow fracture in children, compared to non-surgical treatment. These findings are expected to significantly impact treatment protocols and result in substantial cost savings for the NHS.
The study, named SCIENCE (Surgery or Cast for Injuries of the Epicondyle in Children's Elbows), was published in The Lancet. It represents the largest multi-centre, randomized controlled trial of its kind, providing evidence for the treatment of displaced medial epicondyle fractures of the elbow.
This type of fracture involves a small piece of bone breaking off the inside of the elbow, often due to strong muscles and tendons pulling it away. It accounts for approximately 10% of pediatric elbow injuries, typically affecting children aged 10-12, often after falls during sports.
Despite its common occurrence, global debate has persisted regarding whether surgical fixation or non-surgical care (using a cast or splint) is more effective. The SCIENCE study was initiated to provide robust scientific evidence for treatment decisions in children's orthopaedic surgery, addressing a trend towards surgical fixation without strong supporting data.
The study involved 334 children, aged seven to 15, across hospitals in the UK, Australia, and New Zealand, all with displaced medial epicondyle fractures. Participants were randomized into two groups: one treated with a cast for four weeks, and the other undergoing surgery to fix the bone.
Key findings indicated that healing naturally in a plaster cast was as effective as surgery, while also avoiding the complications associated with an operation. Children in both groups showed similar rates of recovery, return to sports and music hobbies, and comparable levels of pain and hospital visits. The non-surgical group experienced slightly less time off school.
A significant difference was observed in secondary procedures: one in seven children who had surgery required a second operation, usually to remove the screw. In contrast, only one in 45 children treated with a cast later needed an operation for bone healing. Professor Matt Costa, trial lead at the University of Oxford, stated that the study provides clear evidence that surgery should no longer be considered for these fractures in children, potentially saving children from unnecessary operations and reducing NHS costs.
The National Institute for Health and Care Research (NIHR) funded the study, with additional support from the NIHR Oxford Biomedical Research Centre (BRC).