Orthopedic injuries account for one-half of all emergency department visits by pediatric patients in the United States. Although radiography is the first-line method of diagnosis in the emergency department, multidetector computed tomography (CT) is playing an increasingly important role in definition of skeletal and soft-tissue injuries in the pediatric trauma patient. With the advent of 64-detector row CT, images can be produced with subsecond gantry rotation times and with submillimeter acquisition, which yield true isotropic high-resolution volume data sets. This technique is particularly advantageous in the evaluation of pediatric patients because it may eliminate the need for sedation and minimize dependence on patient cooperation. The role of three-dimensional volume imaging in the evaluation of fractures and soft-tissue injuries in pediatric patients continues to evolve as this technique increasingly enables detection and characterization of abnormalities and provides results that affect decisions about patient care.