Summary:Of all fractures in childhood, 6% to 8% are of the lower leg. Orthopaedic treatment is the traditional option in these fractures and was practiced in more than 95% of all patients. The results were unsatisfactory in 6%, predominantly found in shaft fractures with more than one reduction or with extension treatment in unstable fractures of the tibia and fibula on the same level. At the ankle joint, osteosynthesis was used more often (28%), and no bad results were stated. Today's treatments of children's fractures must include primary definitive fracture care and a stabilization adequate for children's wishes for freedom of movement. Therefore, unstable fractures, irreducible fractures, and fractures in which maintenance of reduction cannot be guaranteed reliably by a cast should be stabilized during the first anesthesia. Elastic stable intramedullary nailing is the method of choice in closed and grade I open fractures of the midshaft. In higher‐degree open fractures, comminuted fractures, and special metaphyseal fractures, external fixation is preferred. At the ankle joint, the use of compression screws, Kirschner wires, or tension band wiring is still adequate. Elastic stable intramedullary nailing is characterized by two nails in an opposite threepoint spreading, assisting traction and compression forces and eliminating shear forces. Immediate mobilization and early weight bearing is possible, and there is no need for a supplemental cast. In recent years, orthopaedic treatment in shaft fractures was reduced to 83%, and the portion of osteosynthesis increased to 17%. After surgery we found only one unsatisfactory result in a boy with a refracture and later a 1.3‐cm lengthening. Other length discrepancies were less than 1 cm; all malalignments were less than 10°, and no reduction of ankle movement was stated. Orthopaedic treatment lost the dogmatic position to be the first choice in principle. We must select the method of treatment that seems to guarantee the highest effectiveness with the lowest degree of manipulation in a single case.