(i) Indications for internal fixation of fractures in children

SummaryThe nature of most fractures in children makes them suitable for closed management. However, functional outcomes are not uniformly good and there is evidence that poorer outcomes may be under-reported in children.The role for internal fixation is becoming better-defined. Most Salter Harris type I and II fractures are treated by closed methods while Salter Harris type III and IV fractures almost always require internal fixation. Metaphyseal fractures can be managed as Salter Harris II fractures, but are more likely to require some form of internal fixation.The management of long bone diaphyseal fractures is more controversial. The specific management depends on the bone that is fractured and generalisations regarding treatment are difficult to make. While closed management remains appropriate in most situations, the use of intramedullary fixation has been shown to be effective and safe in a variety of fractures. Care is necessary to avoid rotational malalignment which will restrict range of movement. Both external fixation and plate osteosynthesis have a valuable role in the management of some children's fractures.