A 5-year-old boy was admitted through the emergency department at our district general hospital having fallen in a playground from a ladder approximately 1.5 m high. The limb was significantly deformed, with no evidence of an open injury, and remained neurovascularly intact throughout. Radiographs demonstrated a minimally displaced lateral condyle fracture of the left elbow, a midshaft ulna fracture, and a displaced off-ended distal third radius and ulna fracture of the left wrist (, ). The patient was initially managed emergently in an above elbow plaster cast (, ), with elevation and monitoring for any neurovascular compromise. Computed tomography (CT) imaging was performed to completely assess the fracture pattern and for discussion with our local regional trauma center. CT images revealed Milch Type I fracture; the CT image is poor due to image distortion caused by plaster; hence, an X-ray of the elbow is showed instead (). Given the minimal displacement of the lateral condyle, a conservative course of management was decided on for this. Intraoperatively, an initial attempt to perform a closed reduction of the distal radius and ulna was made but this was unsuccessful. The fracture was not amenable to K-wire fixation due to its diaphyseal-metaphyseal location and so open reduction internal fixation was performed, with a 5-hole Marquardt low profile third tubular plate to achieve anatomical fixation. On table image, intensification was used to confirm congruity and stability of the radiocapitellar joint and radioulnar joints. The angulated midshaft fracture of ulna was manipulated into an anatomical position and an above elbow plaster cast was applied to maintain the minimally displaced position of the lateral epicondyle fracture. The child remained in an above elbow plaster cast for 4 weeks. On immediate removal of the plaster, elbow range of movement (ROM) was from 40 to 100°. A 80° of pronation was retained, but supination was restricted to 20°. No neurovascular deficit was identified and X-rays demonstrated good fracture union (, ). At the 8 weeks post-operative follow-up, elbow ROM further improved, with almost full extension, 120° flexion, 70° of pronation and supination passively but achieving 90° actively on pronation and supination. By 12 weeks after surgery, there was a full ROM of the elbow, wrist, and forearm with complete radiological union (, ). At 13 weeks post-injury, the plate was removed uneventfully and at 2 weeks after the procedure, his wound was well healed, and limb was neurovascularly intact with a full ROM of his elbow, wrist, and forearm at which point he was discharged from our care.