Musculoskeletal trauma in children is a common pathology. One in four injuries secondary to trauma will be accompanied by a fracture. The increasing participation of children in sports activities and the rise of obesity in the child population have generated an upward trend in traumatic injuries. In addition, in recent years there have been a greater number of high-energy injuries from car accidents, fire arms and physical contact fights. The characteristics of the immature skeleton, the great variability of the age range and the presence of growth plates make the management of these injuries a challenge. The objective must be to obtain an optimal result, with the least amount of actions necessary, and to avoid iatrogenic actions that generate progresive sequelae. In the vast majority of cases, orthopedic treatment will be the treatment of choice, leading to a restorative response in children and adolescents. However, there are complex cases, such as exposed fractures, with associated neurovascular injury, polytrauma, or pathological bone lesions, which will require more aggressive treatment and usually surgical procedures.