Surgical treatment of paediatric fractures
When a paediatric fracture may require reduction, K-wires, ESIN/TEN nails or other surgical treatment. Paediatric orthopaedic evaluation in Milan.
Most paediatric fractures heal without surgery. When operative treatment is considered, the choice depends on the fracture site, displacement, age and involvement of the growth plate. This page explains when reduction, K-wires, ESIN/TEN nails or internal fixation may be indicated, and why a perfect radiograph is not always the goal in a growing child.
Informational hub for parents (when to worry, what to bring) →Why paediatric fractures are different
The growing skeleton has features that change how injuries behave and how they are treated. The cortical bone is more elastic, the periosteum is thick and biologically active, and there are growth plates (physes) that can themselves be injured.
Three points guide every decision:
- Remodelling potential: some angular deformities self-correct with growth, so not every displacement requires anatomical reduction.
- Respect of the physis: surgical fixation aims to avoid crossing the growth plate whenever possible (K-wires, ESIN/TEN nails).
- Short, protected immobilisation: children regain motion quickly; formal physiotherapy is rarely needed.
The choice between cast, percutaneous pinning, flexible intramedullary nailing or open reduction depends on age, fracture site, displacement and physeal involvement — and is discussed in detail on each anatomical-site page below.
Fractures by anatomical site
Each page covers indications, surgical technique, recovery and follow-up for that specific site.
Wrist
The wrist is the most common fracture in school-age children. The vast majority are treated conservatively. Surgery has a role only in specific scenarios — and those are the ones worth talking about.
Read the pageForearm
The forearm doesn't just support the hand: it rotates it. That is why, in radius and ulna fractures, alignment matters as much as bone healing.
Read the pageElbow
Some paediatric elbow injuries can be subtle but clinically important. Deformity, marked swelling or pain, neurovascular findings, or suspected displaced fracture require prompt assessment because the joint, nerves, vessels and growth plate may be involved.
Read the pageHumerus
The word «humerus» covers very different fractures. The upper part near the shoulder, the diaphysis, and the lower part near the elbow have different rules, risks and treatment techniques.
Read the pageFemur
The femur is the most important bone of the lower limb. The surgical strategy clearly changes with the child's age and weight: there is no single right answer.
Read the pageKnee
Knee trauma covers very different injuries involving bone, cartilage, ligaments and menisci. The indication for surgery depends on the lesion: instability, osteochondral fragments or repairable injuries may warrant surgery from the outset, while in other cases surgery is considered after an appropriate conservative pathway.
Read the pageLeg
In the leg, bone healing is not enough: axis and rotation must also be watched. A crooked-healing tibia in a child does not always straighten with growth.
Read the pageAnkle
Ankle fractures in children and adolescents cover different patterns: distal tibial and fibular physeal injuries, malleolar fractures and joint lesions. In adolescents, as the distal tibial physis is closing, the typical transitional injuries also appear — Tillaux and triplane fractures.
Read the pageFoot
Most paediatric foot fractures are treated without surgery. Those that do require an operation are few — but often go unnoticed for some days: they are worth knowing about.
Read the pageFractures involving the growth plate
Physeal injuries deserve a dedicated discussion and longer follow-up. See the dedicated page →
Pediatric Fractures: condition information page
Causes, diagnosis, conservative options and when surgery is considered.
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