| Title: |
Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study) : a multicentre, randomised controlled, superiority trial and economic evaluation |
| Authors: |
Perry, Daniel C; Achten, Juul; Zimmermann, Alex; Kandiyali, Rebecca; Appelbe, Duncan; Wright, James G; Ferguson, David; Wang, Kemble; Wilson, Nichola; Moscrop, Amy; Mason, James; Kounali, Daphne; Costa, Matthew L; SCIENCE Study Collaborators |
| Contributors: |
University of St Andrews.Education Division; University of St Andrews.School of Medicine |
| Publication Year: |
2026 |
| Collection: |
University of St Andrews: Digital Research Repository |
| Subject Terms: |
RD Surgery; E-DAS; SDG 3 - Good Health and Well-being; DOAE; MCC; RD |
| Description: |
Funding: National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (17/18/02), with additional support from the NIHR Academy, Oxford NIHR Biomedical Research Centre, and the Starship Foundation (New Zealand). ; Background: Displaced medial epicondyle fractures are among the most controversial injuries in children, with increasing trends towards surgical fixation despite little supporting evidence. Approximately half of affected children undergo surgical fixation, while others receive non-surgical care. The SCIENCE trial aimed to determine whether surgical fixation to restore the position of the bone provides superior functional outcomes and is cost-effective compared with non-surgical care. Methods: We conducted a pragmatic multicentre, randomised, superiority trial across 59 hospitals in the UK, Australia, and New Zealand. Recruiting sites were secondary or tertiary care hospitals providing acute paediatric trauma care. Eligible participants were aged 7-15 years with a displaced medial epicondyle fracture and patients were excluded if the injury occurred more than 2 weeks prior, they had a medial epicondyle fragment that was incarcerated (trapped) within the joint, the injury was part of a complex elbow fracture (ie, extending into the joint), or there were additional fractured bones outside of the elbow. Participants were randomly assigned (1:1) to either surgical fixation or non-surgical care using a web-based randomisation software from Oxford Clinical Trials Research Unit, with minimisation (including a random element) stratified by centre and elbow dislocation status at presentation. Participants and their parents and carers could not be masked to treatment. Surgical fixation was performed under general anaesthesia and involved a surgical incision, restoration of the anatomical alignment, and fixing the fragment, typically with a screw or wires. Non-surgical care involved immobilisation of the elbow at approximately 90° of flexion using a cast, splint, or sling. Both ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| Relation: |
The Lancet; 331802795; https://hdl.handle.net/10023/33536 |
| DOI: |
10.1016/S0140-6736(25)02098-7 |
| Availability: |
https://hdl.handle.net/10023/33536; https://doi.org/10.1016/S0140-6736(25)02098-7 |
| Rights: |
Copyright © 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd. All rights reserved. |
| Accession Number: |
edsbas.FD7107E2 |
| Database: |
BASE |