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Musculoskeletal injuries in children offer unique challenges compared with those in adults. Even low-energy injuries that involve the physis have the potential to cause a growth disturbance that could require treatment. Higher-energy injuries can be complicated by the same soft-tissue disruption, fracture contamination, and bone loss that are seen in adults.

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Gun-related violence is becoming increasingly more common in the United States, and ballistic injuries pose a challenge to the orthopaedic surgeon on trauma call. The guiding principles of trauma care are almost exclusively based on blunt trauma, and the management principles do not always translate. Ballistic long bone fractures, particularly of the lower extremity, can often be managed with similar principles, although the injury pattern can make restoration of anatomic alignment a challenge.

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