Background and objective With significant advancement in the field of biomaterials, alternatives to conventional fiberglass casts such as customized three-dimensional (3D) orthotics have been developed. However, there is a scarcity of reported experience regarding 3D-printed orthoses. The purpose of this study was to compare radiographic outcomes and patient satisfaction with fractures treated with either conventional or 3D-printed casts. Materials and methods We included 23 limbs from 22 patients, who were aged between 8-18 years, and with a diagnosis of an acute nondisplaced wrist or forearm fracture. Patients were randomized into two groups: consisting of those treated with a 3D-printed orthosis and those with conventional fiberglass cast. Outcomes included X-ray alignment and healing, cast fit, the appearance of the skin, ease of care, and overall satisfaction. Results Of note, 10/11 (91%) in the 3D cast group healed in an excellent position, and 1/11 healed in an acceptable position. Also, 11/12 (92%) in the conventional cast group healed in an excellent position, and 1/12 healed in an acceptable position. Radiographically, 11/11 (100%) of the fractures in the 3D group and 11/12 (92%) in the conventional cast group were found to be fully healed. No differences were found in terms of skin irritation by a blinded hand therapist. Patients reported significant differences in skin irritation, comfort, satisfaction, and cast care favoring 3D casts (p<0.05). Conclusions 3D orthoses offer a promising opportunity to improve patients' experiences with upper extremity casting while also providing appropriate immobilization.