TREATMENT OF LONG BONE FRACTURES IN CHILDREN: SURGICAL VERSUS CONSERVATIVE TREATMENT AND FUNCTIONAL OUTCOMES: A SYSTEMATIC REVIEW

Introduction: Long bone fractures in children represent a substantial proportion of pediatric trauma and remain a source of therapeutic controversy due to skeletal immaturity, high remodeling potential, and growth plate considerations. Although conservative management has historically been favored, recent advances in surgical techniques and implants have led to increasing operative rates in selected fracture patterns. The relative benefits of surgical versus nonoperative treatment across different anatomical locations and age groups remain incompletely defined. Objective: To compare surgical and conservative treatment modalities for pediatric long bone fractures with respect to functional outcomes, complication rates, time to union, and need for secondary interventions, and to evaluate variations according to anatomical site, age group, and fracture characteristics. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Electronic databases including PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and the International Clinical Trials Registry Platform were searched for comparative studies published within the last five years, with extension to ten years when necessary. Randomized controlled trials and comparative cohort studies evaluating operative versus nonoperative management of long bone fractures in children and adolescents were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools, and certainty of evidence was evaluated using the GRADE framework. Results and Discussion: Twenty comparative studies were included, encompassing fractures of the femur, tibia, humerus, and forearm. Surgical treatment was associated with lower rates of redisplacement and earlier mobilization in selected unstable fracture patterns, particularly femoral and tibial shaft fractures in older children and adolescents. However, long-term functional outcomes were frequently comparable between operative and conservative approaches when acceptable alignment was achieved and maintained. Conservative management remained highly effective in younger children and stable fracture configurations, provided that appropriate casting technique and radiographic follow-up were ensured. Heterogeneity in study design, outcome measures, and fracture classification systems limited direct quantitative synthesis, and most available evidence derived from observational cohorts. Conclusion: Both surgical and conservative strategies can achieve satisfactory union and functional recovery in pediatric long bone fractures when appropriately selected. Treatment decisions should be individualized according to fracture stability, anatomical location, patient age, remodeling potential, and capacity for follow-up. Further high-quality randomized trials and standardized functional outcome reporting are needed to refine evidence-based treatment algorithms.