Indications for operative treatment of fractures in childhood.

Fractures in children heal more quickly than in adults. Stiffness of joints hardly ever occurs in children, even after prolonged immobilization. Pseudoarthrosis and Sudeck's atrophy are extremely rare. Axial, lateral and longitudinal malpositioning can be largely compensated by increased growth. Only rotation malpositions remain permanent in children. By and large, the treatment of fractures in childhood is therefore still conservative. Operative treatment is recommended for some types of fractures near joints, for fractures of the neck of the femur, and for some types of the fractures around the elbow. In all other types of fractures surgery should only be undertaken when the conservative methods fail. An exception may be in adolescents over 12 to 14 years of age and children with multiple trauma, especially cerebral trauma with consecutive spasticity. In these patients, conservative treatment with extension may be difficult and an osteosynthesis may facilitate general care.