Objective:

To evaluate the non-inferiority of nonsurgical casting compared to surgical reduction in pediatric patients with severely displaced distal radial fractures, emphasizing the comparative aspect.

Key Findings:

• Mean function scores at 3 months were lower in the casting group (44.9) compared to the surgical group (46.6), with a mean difference of -1.64 points that crossed the non-inferiority margin.
• Nonsurgical casting did not meet the non-inferiority criteria.
• Differences in function diminished over time, with no significant difference at 6 and 12 months.
• Surgical group had better cosmetic scores and slightly higher quality-of-life measures early on, but differences narrowed by 12 months.
• Complications were more frequent in the surgical group, including wound infections and nerve irritation.

Interpretation:

The observed difference in favor of surgical reduction was small and did not persist beyond early recovery, suggesting that nonsurgical casting may be a viable option for certain patients, impacting clinical decision-making.

Limitations:

• Conservative non-inferiority margin, which may affect the interpretation of results.
• Crossover between treatment groups could introduce bias.
• Restriction to patients aged 4 to 10 years limits generalizability to older patients.
• Variation in care across centers may influence outcomes.

Conclusion:

Nonsurgical casting is associated with lower costs and remains cost-effective, but may not provide equivalent functional outcomes compared to surgical reduction in the short term, emphasizing the need for careful consideration in clinical practice.