ArticleJournal of the Pediatric Orthopaedic Society of North America2026
Pediatric Both Bone Forearm Fractures: Re-evaluating Unacceptable Alignment and Remodeling Potential in Children up to 11 Years Old.
Article in Journal of the Pediatric Orthopaedic Society of North America, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Nonoperative management utilizing closed reduction and immobilization is considered standard of care for pediatric both bone forearm fractures (BBFFs) when alignment meets Noonan and Price criteria (JAAOS 1998). A previous series of patients at our institution revealed a subpopulation who healed outside of these parameters but were asymptomatic. Methods: A prospective study of patients with healed fractures at standard 6 to 12-week follow-up with residual sagittal or coronal angulation ≥15° was performed with minimum 2-year follow-up. Patients underwent forearm radiographs, physical examination, and completed PedsQL (Pediatric Quality of Life Inventory). Radiographs at 2 years were compared to those taken at the last standard follow-up to evaluate remodeling. Physical examination was compared between the normal and injured sides and to published norms. PedsQL scores below 1 standard deviation (SD) from the published mean were considered abnormal. Results: Forty-eight patients, with initial malunions ≥15° in either plane were identified from 203 eligible patients from 2019 to 2021, and 22 patients (average age: 7.1 years, range: 2.1-11.5) returned for 2-year follow-up. No patients had a residual angulation ≥15°. All patients demonstrated functional range of motion. Five (23%) patients had a ≥10° difference in pronation compared to the uninjured side but showed no significant difference in other outcome or demographic variables compared to those with normal pronation ( Conclusions: Pediatric BBFFs demonstrated significant remodeling potential without long-term consequences to function or patient-reported outcomes at 2-year follow-up. Although this study has a small population of primarily young patients, it does include 6 patients 9-11 years of age. This may support re-evaluating current recommendations for acceptable alignment of pediatric BBFF in this group. Key Concepts: (1)Both bone forearm fractures with ≥15° malunion at 6-8 weeks post injury have the capacity to remodel in patients up to 11 years of age.(2)Significant range-of-motion deficits did not develop in these observed both bone forearm fracture malunions. Level of Evidence: II.
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