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Sex-Based Anatomical Variations and Complication Risks in Pediatric Both-Bone Forearm Fractures: A Level of Evidence
Onur Cetin1, Ali Can Koluman2, Mesut Demirkoparan3
1Department of Orthopedics and Traumatology, Istanbul Medipol University, 34815 Istanbul, Türkiye.
Background:
Both-bone forearm fractures (BBFF) are among the most common pediatric injuries. While most cases in younger children can be managed non-operatively, older children and adolescents exhibit less predictable remodeling and longer healing times, potentially leading to higher complication rates. This study aimed to evaluate sex-based anatomical differences in BBFF and their association with complications.
Methods:
We retrospectively reviewed 163 patients (129 boys, 34 girls; age range: boys > 10 years, girls > 8 years, both < 16 years) with unilateral BBFF treated between 2017 and 2020. All underwent biplanar radiographs of both forearms pre-reduction, post-reduction, and at 8-week follow-up. Measurements included radius and ulna angulation, bone length, maximum radial bow (%), and location of maximum bow (mm). Complications and surgical interventions were recorded.
Results:
Boys demonstrated significantly greater initial radius angulation on the lateral view (p < 0.05) and longer radius and ulna lengths on the unaffected side (p < 0.05). Maximum radial bow (%) did not differ between sexes; however, the location of maximum bow varied between unaffected and fractured sides within each sex (p < 0.05). Twenty boys (15.5%) required surgery, compared with none of the girls (p = 0.007). Overall complication rates were 44.8% (n = 73) with no significant sex difference (p = 0.074).
Conclusions:
In older children and adolescents with BBFF, boys exhibit anatomical characteristics-such as longer forearms and greater initial angulation-associated with unstable fracture patterns and higher surgical intervention rates. Recognizing these differences may improve early risk stratification and management strategies.
Level Of Evidence:
IV.
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