Research & Clinical Trials

What is Clinical Research in Trauma & Orthopaedics?

Clinical research in trauma and orthopaedics involves working directly with patients to advance our understanding of musculoskeletal injuries and conditions, and the most effective ways to treat them. This typically means comparing different treatment approaches — such as surgery versus non-operative care — to determine which delivers the best functional recovery, lowest complication rates, and highest patient satisfaction.

The goal is straightforward: to ensure that treatment decisions are guided by robust, high-quality evidence rather than habit or assumption. Every child who participates in a clinical trial contributes to a body of knowledge that shapes how future patients across the world are treated.

Mr Nev Davies has always been passionate about research and delivering the best possible outcomes for his patients. He serves as lead for paediatric research within the Trauma and Orthopaedics department at the Royal Berkshire Hospital, and has acted as Principal Investigator on numerous NIHR-funded national studies over the past decade. With the support of an outstanding research team, the Royal Berkshire has consistently performed well nationally in recruiting patients to these important trials.

Landmark Publications · 2025 / 2026

Two Major Studies. Two Lancet Publications. One Team.

This past year marks an extraordinary milestone for children's orthopaedic surgery. Two multicentre, NIHR-funded randomised controlled trials in which the Royal Berkshire participated have now published their findings in The Lancet — the world's most prestigious medical journal — with results that will change clinical practice for children with fractures across the UK and beyond.

SCIENCE Study

Surgery or Cast for Injuries of the Epicondyle in Children's Elbows

Multicentre randomised controlled trial · 59 hospitals · UK, Australia & New Zealand · Published in The Lancet, January 2026

Medial epicondyle fractures — where a small piece of bone breaks away from the inside of the elbow, often after a fall during sport — account for around 10% of all paediatric elbow injuries. Despite being a common injury, the best treatment had long been one of the most hotly debated questions in children's orthopaedic surgery. Approximately half of all children with this injury were being treated surgically, based largely on tradition rather than strong evidence.

The SCIENCE trial was the largest randomised controlled trial of its kind ever conducted, recruiting 334 children aged 7 to 15 years across 59 hospitals in the UK, Australia, and New Zealand. Half were treated with a plaster cast for four weeks; the other half underwent surgical fixation. Arm function was measured at 12 months using validated patient-reported outcome tools.

Non-surgical treatment with a plaster cast was shown to be as effective as surgery at 12 months, with no meaningful difference in arm function or patient-reported outcomes.

Children treated without surgery avoided all operative complications — including infection, nerve irritation, and scarring — and returned to school and normal activities sooner.

Non-surgical care was significantly cheaper for the NHS, with major cost savings per patient — findings that could transform commissioning decisions nationally.

These results represent a paradigm shift. For the first time, clinicians and families can be confident that in most cases, a plaster cast alone is the right choice — sparing children from an operation that offers no additional benefit.

Read the full paper in The Lancet (Open Access): https://doi.org/10.1016/S0140-6736(25)02098-7

CRAFFT Trial

Children's Radius Acute Fracture Fixation Trial

Multicentre randomised controlled trial · 49 hospitals · UK-wide · Published in The Lancet, April 2026

Broken wrists are the most common fracture in children, accounting for around half of all childhood fractures seen in emergency departments. When the bones are severely displaced — moved significantly out of their normal position — UK practice has traditionally been to operate under general anaesthetic to realign them before applying a plaster cast. But is that surgery always necessary?

Unlike adults, children possess a remarkable capacity to straighten bones naturally as they heal, in a process called remodelling. The CRAFFT trial was designed to find out whether a plaster cast alone could achieve the same long-term outcome for children with severely displaced distal radial fractures, without exposing them to the risks of an operation. The trial recruited 750 children aged 4 to 10 from 49 hospitals across the UK — one of the largest paediatric orthopaedic trials ever conducted in the country.

At six and twelve months, there was no meaningful difference in arm function between children treated with surgery and those treated with a plaster cast — the early, modest advantage seen with surgery at three months did not persist.

Surgery was associated with complications including infections, nerve irritation, and scarring, none of which were present in the non-surgical group.

Non-surgical treatment reduced NHS costs by an average of approximately £1,600 per patient — a significant system-wide saving if adopted as standard practice.

The results support a cast-first approach for most children with this injury, potentially sparing thousands of children each year from an unnecessary general anaesthetic and surgical procedure — without compromising their recovery.

Read the full paper in The Lancet (Open Access): https://doi.org/10.1016/S0140-6736(26)00409-5

Proud to Be Part of Research That Changes Lives

The Royal Berkshire research team's consistent national performance in recruiting patients to these trials has directly contributed to evidence that will improve the care of injured children across the UK and worldwide. We are grateful to every family who chose to take part.