The treatment of fractures in growing children has been a problem for orthopaedic surgeons since the mid-19th century when French physicians treated elbow injuries in children. The complexity of treatment and the uncertainty of outcome often put orthopaedic surgeons in an awkward dilemma. Epiphyseal injuries in children remain one of the most difficult problems for physicians, even with the rapid development of various treatment techniques, compared to the difficulty of managing pediatric diaphyseal fractures. Especially in today’s special medical environment, how to accurately and reasonably treat children’s fractures and avoid medically induced injuries and consequent medical disputes is an urgent problem to be solved. There is no doubt that the vast majority of closed fractures in children are still treated by the preferred method of manipulation and closed reduction. It is inappropriate to treat fractures in children that can be treated by closed reduction with surgery and internal fixation for any reason. This is a basic principle that needs to be emphasized! Of course, with changing times and changing needs, it is no longer possible for children with fractures to be hospitalized for too long, and the pressure of heavy schooling and homework does not allow children to be bedridden for long periods of time without missing classroom education; they need to return to school and to their classmates as quickly as possible. This requires the pediatric orthopedic surgeon to find the most effective treatment modality that meets the needs of the child and allows them to return to normal life and school as quickly as possible, without compromising the effectiveness of treatment. In order to meet the new requirements of the population for the treatment of children’s fractures, and with the rapid development of relevant scientific research and technology, various techniques and surgical methods suitable for children’s fractures have emerged, and the concept of minimally invasive surgery has become more and more acceptable to doctors and patients. Among them, the treatment of supracondylar fractures in children is the most representative. As one of the most common fractures in children, the traditional treatment methods used in the past did have the disadvantage of not being humane enough. Today, the commonly used method is to reposition the fracture by manipulation after anesthesia for pain relief, and to fix it by percutaneous needle penetration with a short period of external plaster fixation for protection. This method can avoid the problems of closed reduction and plaster fixation, and the child does not have to endure the pain of the reduction; the percutaneous needle can effectively prevent the redisplacement of the fracture, and the incidence of inversion of the elbow, which used to be as high as 15-30%, can be significantly reduced; at the same time, it can avoid the risk of dysfunction of the elbow joint due to the unacceptable position and the use of incisional reduction. This treatment is now the preferred method for displaced supracondylar humerus fractures and is widely accepted by pediatric orthopedic surgeons. Improvements in the treatment of femoral stem fractures in children are also convincing examples. Traditionally, hospitalization was followed by skin traction or bone traction for 4 to 6 weeks or even 8 weeks until the fracture was clinically healed and then discharged. Although there is no doubt about the effectiveness of this treatment, the child is unable to receive normal education for a considerable period of time, and may even apply for repetition for this reason, which becomes a difficult problem for the child and parents to accept. In today’s environment of exam-oriented education, the fierce competition in studies does not allow the child to be out of the “battlefield” for such a long time! Therefore, we have adopted a variety of internal fixation methods to treat children with femoral stem fractures to ensure that they can return to the classroom as soon as possible. For example, flexible intramedullary pin technique, external fixation frame technique, and locked intramedullary pin technique are used for different ages and various fracture types. Satisfactory treatment results have been achieved. Multiple fractures in children are always a difficult problem that pediatric orthopedic surgeons are reluctant to face. According to the principles of fracture treatment, multiple fractures require strong internal fixation to facilitate the treatment of other systemic injuries and early initiation of joint motion and muscle exercises to shorten the rehabilitation time. However, the skeletal characteristics of children make it impossible to obtain strong internal fixation in many cases, even without the space necessary for its use! The therapeutic advantages of the elastic intramedullary pin technique are undeniable, and it can be said that the invention of this technique has opened up a whole new field in the treatment of fractures in children. The elastic intramedullary pin technique is a minimally invasive procedure, which is in line with the current trend in the treatment of diseases in the field of surgery. It has a series of advantages such as less damage, rapid healing and shorter hospitalization time for the treatment of pediatric diaphyseal fractures, and can avoid the damage to the periosteum and soft tissues caused by the incisional internal fixation surgery and the blow of the second surgery to remove the internal fixation. It has become the preferred method in the field of pediatric orthopedics for the treatment of pediatric diaphyseal fractures internationally, and its effect has been widely accepted by pediatric orthopedic surgeons and patients. There is still no revolutionary breakthrough in the treatment of intra-articular fractures and epiphyseal growth plate injuries, and the basic principles and methods of treatment for epiphyseal injuries are still used. However, it is important to differentiate the use of various artificial materials and surgical methods for different fracture types, ages, and locations, and to strictly follow the principles of epiphyseal injury treatment to minimize the impact of the injury on the growth mechanism of the child. Although it is still not possible to prevent the occurrence of deformities after epiphyseal injury, what we can do is to at least avoid “medically induced damage” to the epiphyseal growth plate. On the other hand, we are actively treating post-epiphyseal deformities, especially angular deformities, with bridgework and epiphyseal openings, depending on the patient’s condition, and have achieved initial results. There is still a long way to go in the treatment of children’s fractures, and there are still many problems that cannot be solved well. We would like to work together with our colleagues to raise the level of treatment of children’s fractures to a new level.