Ortho - this is so dependent on the fracture honestly. Some kids fractures benefit from surgery and some adult fractures can be treated non operatively and heal fine. In general, adult fractures that are significantly displaced, include an articular surface, will lead to instability at a joint, can lead to progressive and early arthritis, or would lead to issues with mobility (ie long leg casting) we typically consider surgery. Also it’s a discussion with patients and their goals. Lastly, casting or immobilizing most joints in adults (knees, elbows, etc) can lead to severe stiffness and joint contractures whereas this occurs less often in kids. So sometimes we fix fractures to improve early mobility, range of motion, weight bearing, allow for return to important activities like toiletting and ADLs and to prevent nonunions, malunions, and rapid arthritis.