Professor Dan Perry is a children’s orthopaedic surgeon and NIHR Research Professor at Alder Hey Children’s NHS Foundation Trust.
This World Health Day, Prof Perry looks at how we can combine research, evidence and facts to generate science-based guidance to improve the healthcare of children and young people.
“Hi, I’m Dan Perry. I’m a children’s orthopaedic surgeon and NIHR Research Professor here at Alder Hey. Each week I treat children with broken bones, hip problems, infections and joint conditions.
Alongside my clinical care, I lead Alder Hey’s Trauma, Orthopaedic and Emergency Care research programme, which is one of the largest coordinated clinical research portfolios in children’s surgery in the world.
This work is not separate from clinical care; instead, it is built into everyday NHS practice. It brings together surgeons, emergency clinicians, physiotherapists, research nurses, data scientists and university partners across the UK and beyond. The goal is to make sure children receive treatments proven to work, not just widely believed to work.
This is one of the reasons Alder Hey stands out globally.
Why Children’s Surgery Needs to be Tested
Most people assume that if an operation is commonly performed, it has been tested properly. The reality is way more complex.
Surgery often evolves through training and tradition. Operations are taught, repeated, refined and gradually become standardised. Yet many of these operations have never been properly tested – particularly in large, high-quality randomised studies. This can lead to huge variation, where the same disease/injury may be treated very differently depending on which hospital a child attends.
Children deserve medical decisions to be grounded in robust evidence and families deserve clarity when faced with difficult choices. At Alder Hey, that principle underpins all our research.
Trials That Have Changed Practice
SCIENCE – when routine surgery turns out not to be better.
One of our largest international trials was the SCIENCE study. SCIENCE focused on examining a common injury on the inside of the elbow (a medial epicondyle fracture). Surgery for this type of injury had been increasing and in many places was becoming routine, despite limited evidence showing it was better than a plaster cast. So we tested it…
We ran a multicentre randomised trial across more than 60 hospitals in the UK, alongside centres in Australia and New Zealand. This study was only possible because families put their trust in the process. In total, 334 families took part, allowing randomisation to decide between surgery and plaster cast treatment. That level of trust, when the decision involves a potential operation, is extraordinary and it carries the responsibility to deliver clear answers.
By the end of the study, we had that clear answer. Surgery was no better than a plaster cast for the outcomes that matters most to children.
For families, this means avoiding an operation without compromising recovery: fewer scars, fewer risks and a lot less stress.
These findings were published in The Lancet, which is widely regarded as the world’s leading medical journal.
FORCE – simplifying care for thousands of families
We also led the FORCE study, with results also published in The Lancet.
FORCE looked at a very common wrist fracture in children. For years, rigid casts and routine hospital follow-ups were standard. But was that the only way?
Through the study, we showed that a simple soft bandage worked just as well.
That one trial has reduced thousands of unnecessary clinic visits annually for families across the NHS, creating a practical and immediate benefit for children and parents.
CRAFFT – the next major result
The next big study CRAFFT, has also finished recruitment. CRAFFT focuses on severely displaced wrist fractures, where surgery is often used to straighten and fix the bone.
The reality is that most children have a remarkable ability to heal themselves. Their bones can remodel as they grow! It’s a superpower in children.
The CRAFFT study asks the bold question: is surgery always necessary, or are children’s natural healing power enough?
The results of this study are been shared in The Lancet, this week!
Taken together, SCIENCE, FORCE and CRAFFT represent a consistent approach: identifying high-impact questions, running definitive trials, publishing at the highest level and changing the practice for children.
Collaboration for Children
Here at Alder Hey, we have a structured programme with growing research leadership across our team.
Mr Nick Peterson leads national multicentre trails including ODD SOCKS, which looks at ankle fractures in children. Dr Shrouk Messahel leads funded research examining antibiotic use in children, addressing an area with significant variation in care.
Alongside there are PhD students, research fellows, clinical research practitioners and specialist governance staff based at Alder Hey and supported by university partners at Liverpool and Oxford.
We’ve also got studies for children affected by Perthes’ Disease (OpNonSTOP), Scoliosis (BASIS), Cerebral Palsy (SPELL and ROBUST) and many more conditions.
This means Alder Hey is not just producing influential studies, we are building capability to deliver them consistently, at scale and long term.
Shaping the Future of Children’s Surgery
As we celebrate World Health Day, which this year is themed Together with health: stand with science, it is worth noting that Alder Hey we embed this theme in our culture. Alder Hey has one of the largest teams of children’s orthopaedic surgeons and emergency doctors in Europe and treats a high volume of patients each year. Our strength at Alder Hey is not our size, but our willingness to question routine practice, generate robust evidence and change healthcare for children and young people.
Children deserve the strongest possible evidence behind every clinical decision.”
Dan