OBJECTIVES To evaluate the pattern of fractures in children in the south eastern region of Nigeria, seeking to highlight the planning and designs of buildings, roads and playgrounds to prevent paediatric fractures. DESIGN Retrospective review of paediatric patients with fractures who presented at the only tertiary referral centre in the region. SETTING A university teaching hospital situated in the south eastern corner of Nigeria. SUBJECTS 102 paediatric patients treated for fractures between January 1993 and December 1995. MAIN OUTCOME MEASURES Causes of fractures and their anatomical distribution. RESULTS 71 boys and 31 girls were treated for fractures. The commonest cause of fractures was road traffic accidents accounting for 50% of the patients, followed by falls and collapsing mud walls. Most of the fractures seen (58 patients) were of the green stick type. The femur was the commonly fractured bone (25 patients) followed by the radius (22 patients) and humerus (20 patients). Road traffic accident victims presented earlier at the hospital than victims of other causes. Also lower limb fracture patients presented earlier than patients with upper limb fractures. CONCLUSION Paediatric fractures are amenable to conventional conservative therapy and open reduction became necessary in long neglected cases with associated malunion. Since the causes of fractures are largely preventable, public enlightenment campaigns, provision of pedestrian pathways, care on the part of school authorities and proper structural construction of the traditional houses may help reduce the number of cases of fracture in our environment.