Purpose <p>Purpose of the study was to report the antibiotic treatment and complications after open fractures in children and adolescents at a level one trauma center.</p> Methods <p>We retrospectively report data of 72 children and adolescents with 74 open fractures. The open fractures were evaluated according to severity, etiology, localization, concomitant injuries, therapeutic treatment, concomitant antibiotic treatment, complications and outcome.</p> Results <p>We found a significant relationship between the occurrence of complications and the severity of the open fractures, the treatment method, the mechanism of injury and for the localization. A correlation between the occurrence of complications and the antibiotic treatment could not be shown.</p> Conclusions <p>As the degree of injury increases, so does the likelihood of complications. There is also a correlation to treatment with external fixation, non-primary wound closure, traffic accidents and when the lower leg or foot is affected. However, the cause-and-effect relationship should always be considered.</p>