The physiology of the growing skeleton must be understood to treat fractures in children and adolescents. Misunderstanding the particular concerns for treating fractures in this age range generally leads to treatment failures. Fracture management begins with pain relief and child abuse detection. Treatment is to repair the fracture and preserve limb function. Consider the remaining skeletal development growth. Pediatric traumatologists must predict fractured bone growth. Conservative and surgical treatments are combined during skeletal development. Fractures around the elbow, like supracondylar humeral fractures, displaced radial condyle fractures, radial neck fractures, and radial head dislocations, are called "Monteggia lesions" and require a special kind of knowledge. These issues cause the most avoidable fracture healing failures in children and adolescents. This article describes the recent advances in management of fractures in the arm.