Tendency towards operative treatment is increasing in children's fractures: Results obtained from patient databases, causes, impact of evidence-based medicine

Results of numerous studies assessing the national or the local patient databases in several countries have indicated that the overall rate of operative treatment in fractures, as well as the rate in certain upper and lower limb fractures, has significantly increased in children. The most prominent increase in the rate of operative treatment was observed in forearm shaft fractures. Results of several survey studies have revealed that there was not a high level of agreement among paediatric orthopaedic surgeons concerning treatment preferences for several children's fractures. The reasons for the increasing tendency towards operative treatment are multifactorial and patient-, parent-and surgeon-dependent factors as well as technological, economic, social, environmental and legal factors seem to have an impact on this trend. It is obvious that evidence-based medicine is not the only factor that leads to this tendency. A high level of scientific evidence is currently lacking to support the statement that operative treatment really leads to better long-term outcomes in children's fractures. Properly designed multicentre clinical trials are needed to determine the best treatment options in many fractures in children