The “personality” of the fractures seen in children is quite different from that of the fractures seen in adults. Thus, almost all fractures in children will unite, regardless of type of treatment, and non-unions are extremely rare in this age group.

Further, as the growth plates are open, angular deformities as well as axial shortenings, sometimes seen after primary union of long bone fractures, may be partly or even completely corrected by remaining growth. On the other hand, growth plate injuries require special consideration at the initial management (of, for instance, ankle joint injuries) in order to prevent future growth disturbances. Correct assessment of the initial radiographs, which is a prerequisite for successful management of the fractures, may be difficult because of incomplete ossification of the skeleton. All these factors and many more must be considered in the management of fractures in children.

Blount, in his excellent textbook entitled: “Fractures in Children” (first edition published in 1955), advocated that almost all fractures seen in children should be treated by non-surgical methods. His principles have been practised worldwide for many years. However, during recent years a surgical approach has been adopted at many centres for some of the fractures seen in children. Thus, displaced supracondylar fractures of the humerus are today commonly treated by percutaneous pinning, midshaft fractures of the forearm are treated by closed intramedullary fixation with flexible nails, fractures of the shaft of the femur in older children are managed in a similar way by intramedullary fixation or by use of external fixators, etc. It is claimed that by using these surgical techniques excellent results can be achieved without increased risk of complications, and that a considerable amount of money for medical care can be saved as the children can be discharged from the hospital a few days after surgery.