Epidemiology and Management of Traumatic Paediatric Orthopaedic Emergencies: A Narrative Review

Background Traumatic musculoskeletal injury is among the commonest reasons for a child to attend an emergencydepartment, yet the growing skeleton behaves in ways that make adult fracture principles an unreliable guide. Thephysis is weaker than the ligaments spanning it, the periosteum is thick and vascular, bone may fail in compressionas readily as in tension, and remodelling potential varies by site, age and plane of deformity. Methods This narrative review synthesises evidence published between 2015 and 2026, supplemented byfoundational earlier work, on the epidemiologically commonest and clinically most consequential traumaticpaediatric orthopaedic emergencies. Scope After summarising the global and setting-specifi c epidemiology of paediatric fractures and the appliedanatomy of the immature skeleton, we address physeal injury and the Salter-Harris classifi cation, injuries of theupper limb (clavicle, supracondylar humerus, forearm and distal radius, phalanx), lower limb (femoral shaft, tibia)and pelvis. Three other important emergencies; open fractures, acute compartment syndrome and non-accidentaltrauma are considered separately because they alter management irrespective of fracture site. Conclusion In management of these fractures, recurrent themes emerge: The need for serial neurovascularexamination over a single assessment; the pre-eminence of clinical over pressure-based diagnosis in paediatriccompartment syndrome; the quantifi able growth-arrest cost of repeated manipulation; and the obligation to considerinfl icted injury in any child whose injury pattern does not align with the history offered.