Musculoskeletal trauma is common in children, resulting in over 1/3 of all pediatric ED visits. Although these injuries rarely result in death, they are a frequent component of multisystem trauma. The skeletal system is still developing in children and bones are flexible. Buckle fractures are caused when bone is compressed by axial loading and Greenstick, or incomplete fractures are common. Fracture should be suspected with point tenderness even in the absence of secondary signs such as deformity, swelling or ecchymosis. Growth plates are not yet closed in pediatric patients. These weak cartilaginous structures are vulnerable to fractures. Injuries involving growth plates leading to Salter-Harris type fractures can cause limb length abnormalities after recovery and long-term disability if not detected and treated appropriately. Significant complications with musculoskeletal injuries include severe hemorrhage, especially with long-bone and pelvic fractures and neurovascular compromise. There is a proportionally greater blood loss with long-bone fractures in children and femoral fractures can result in severe blood loss.