Fracture Remodeling in Children: Which Fractures Remodel and Which Do Not?

Children have the capacity to remodel fractures because of their active physis and periosteum. Orthopaedic surgeons should be aware of the general guidelines that injuries in younger children, children with less displaced fractures, and children with injuries closer to the growth plate are likely to remodel better than in older children with injuries more distant from the growth plate and with more initial deformity. It is also important to recognize that deformity in the plane of motion is generally better tolerated than deformity outside the plane of motion. Rotational malalignment tends to remodel poorly if at all. When evaluating an injury, the physician should consider the growth potential of the physes in the area local to the injury and their likely contribution to the remodeling and healing process when deciding what management is right and what reduction is acceptable.