Stimulating and inhibiting growth disorders can be differentiated. Each fracture of a long bone leads to an excessive growth. The degree depends on the age of the child, the dislocation, the amount and the time of the reposition attempts, and the degree of the necessary remodeling. This leads to an elongation of the specific extremity, which is only relevant for the lower extremity concerning the biomechanical or anatomical structure of the spine. Therefore, regular clinical controls are necessary up to 2 years after the trauma. Partial growth stimulation is uncommon. It only plays a role in fractures of the proximal tibia with resulting increasing valgus or in condyle radial fractures with resulting increasing varus.

Injuries to the physis, directly or indirectly by vessel lesions, can cause early physis closure. A full closure leads to a shortening of the corresponding extremity. Growth disorders with increasing deformity of the axis are caused by incomplete closures. The degree depends on the age and the maturity of the child, the skeleton’s location, the proximity to the physis, and the degree of the dislocation. The occurrence of growth disorders cannot be avoided specifically. Ideal conditions, provided by correct anatomic reposition and avoidance of iatrogenic physis injuries, can only affect the appearance of growth disorders positively. In addition to clinical controls of the axis and length proportions in side comparison, an X-ray dense line, called the Harris line, which usually runs parallel to the physis, can provide a hint of partial growth disorders.

The specialties of the child’s skeleton with the physis, the strong ligaments, and the thick periost as well as the high elasticity of the bone leads to a stereotypic fracture pattern differing from that of adults. Therefore, special fracture forms exist for the child:

The clinical investigation first covers the anamnesis, which identifies the localization of the injury, the energy of the trauma, and the relation of the trauma to possible child abuse or pathological fractures. After a thorough inspection, a careful palpation follows. Young patients should be informed about and provided with explanations of procedures. An examination of the peripheral blood circulation, motor function, and sensitivity should be performed in all cases. Expanded functional tests are mostly unnecessary because of lack of consequence in the acute stage and are potentially painful for the child.

The X-ray diagnostics represent a special challenge. Radiation exposure should be minimized and all technical means should be used to reduce the radiation dose. Because of the large portion of X-ray-permeable cartilage tissue and the characteristics of the still-growing skeleton (e.g., the occurrence of ossification centers), good knowledge of age-dependent diagnostic findings is critical for the examiner. The frequently recommended comparative picture of the opposite side in the diagnosis of fresh injuries does not replace this knowledge and may be inefficient and unnecessary. If an operative indication is already provided by the first picture, a second plane can be avoided for the protection of the child. This can be accomplished under anesthesia. For all other fractures, the X-ray in two planes (anteroposterior, or a.p., and laterally) with illustration of the adjoining joint is standard. Injury-centered pictures should be aimed for and overview pictures in two planes should be avoided for the exact evaluation. In special cases such as transitional fractures, additional diagonal pictures are helpful. Due to the X-ray-permeable cartilage tissue, some injuries can only be recognized by an extension of the growth joint or a dislocation of the adjoining bone.

Sonography is available as a preserving procedure in the evaluation of X-ray-permeable structures such as tendons, ligaments, and non-ossificating skeleton portions. Fractures can also be diagnosed directly and indirectly by proof of a subperiosteal hematoma or an accompanying hemarthrosis.

Computed tomography, primarily as a multilayer CT, applies the diagnostics of the polytraumatized child as well as of complex fractures of the spine, the basin, or the foot root with the possibility of low-dose programs. MRI offers a large range of application possibilities. It allows the demonstration of nonossifying skeleton parts, soft tissues, ligaments, and musculature. It is used in the diagnosis of occult fractures, of spine injuries, and of post-traumatic complications of joint and physis injuries, such as the detection of growth disturbances, osteonecrosis, or cartilage flakes. The missing radiation exposure is a further advantage. However, it is still an expensive diagnostic and requires long investigation periods, and often requires sedation or anesthesia in small children.

Other imaging procedures such as scintigraphy, angiography, or arthrography are not applied in routine diagnostics and are reserved for special indications.

In most cases, injuries of the child can be treated adequately by conservative techniques. Usually, an immobilization (e.g., with a cast) is sufficient. At certain localizations, the immobilization in small children takes place with special bandages (e.g., Desault’s bandage at the proximal humerus, the backpack bandage at the clavicle, or the fist bandage at the phalanxes). At certain localizations, secondary dislocations can be prevented and easy malpositions can be corrected by reduction bandages such as cast wedging, extension treatment, or the Cuff ‘n collar.

All completely dislocated or unstable fractures that cannot be turned into a stable fracture by closed reduction are an indication for operative therapy. The aim is to achieve a stable situation to avoid further reductions or changes in therapy. A movement and charge stability should be achieved if possible. Furthermore, factors such as effort (e.g., secondary removal of metal), costs, available resources, and personal experience play a role in the choice of the osteosynthesis method.

Clavicle fractures, accounting for 5–15 % of all fractures, children and adults, belong to the most frequent fractures in the infancy, mostly below the 10th year of life. They usually appear as birth trauma fracture or by direct impact. The fracture is often undislocated in infants because of the thick periosteal tube and leads to a fast fracture healing. Fractures are differentiated into the medial, middle, and lateral third; those in the middle third which occur most often. The therapy usually can be performed conservatively by immobilization in a cotton bandage or by backpack bandage. Consolidation control with still-open growth joints is done clinically by pressure indolent fracture callus and normalization of the function after approximately 3 weeks. Radiological position control is not necessary in that case. Shortenings or side-to-side malpositions will usually be corrected by the reduction within a year. In adolescents, the extent of the spontaneous correction is not sufficient for a complete remodeling. Pronounced malpositions and shortenings should be avoided in this case. In some cases, the danger of skin perforation exists; here, open reduction and osteosynthesis should be accomplished. In addition to the well-known method of plate osteosynthesis, intramedullary splinting by ESIN is a possible alternative.