♦ After forearm and digital injuries, tibial and ankle fractures are the commonest fractures in the immature skeleton and the majority of these involve the diaphysis or ankle

♦ Compared to the morbidity seen in adults these are relatively forgiving injuries in children as the healing rate of bone and soft tissues is rapid and remodelling will occur

♦ It is wise, however, to guard against overconfidence in the remodelling potential of certain injuries; for example, angulated mid-diaphyseal fractures, rotational malalignment, and metaphyseal fractures within 2 years of skeletal maturity

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♦ After forearm and digital injuries, tibial and ankle fractures are the commonest fractures in the immature skeleton and the majority of these involve the diaphysis or ankle

♦ Compared to the morbidity seen in adults these are relatively forgiving injuries in children as the healing rate of bone and soft tissues is rapid and remodelling will occur

♦ It is wise, however, to guard against overconfidence in the remodelling potential of certain injuries; for example, angulated mid-diaphyseal fractures, rotational malalignment, and metaphyseal fractures within 2 years of skeletal maturity

♦ Children will tolerate manipulative/cast treatment better than adults as the duration of treatment is usually shorter and rapid rehabilitation is almost the norm with or without physiotherapy

♦ Postfracture overgrowth does occur but is less than that following femoral fractures and seldom clinically significant (over 10mm)

♦ Isolated fibular fractures are of minor importance but need to be taken into account in managing complex injuries involving the distal tibia

♦ It is convenient to discuss injuries according to three anatomical sections: proximal, diaphyseal, and distal.