These are intraarticular fractures and the adult principles of anatomical reduction and stable fixation are also relevant in children.
If closed reduction, with or without the assistance of a percutaneous K-wire, is unsuccessful, open reduction is required.
Impediments to closed reduction include pronator quadratus, and/or periosteum.
In younger children, fixation can be achieved using a K-wire. A lag screw, totally within the epiphysis, can be used as an alternative near skeletal maturity when the epiphysis is largely ossified.
Preoperative CT imaging is desirable to determine the exact anatomy of the fracture and, therefore, the correct orientation of any intraepiphyseal implant.