Pediatric Both Bone Forearm Fractures: Re-evaluating Unacceptable Alignment and Remodeling Potential in Children up
Olivia Grothaus1, Haley Monson1,2, Jayden Brennan1,2
1Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
Journal of the Pediatric Orthopaedic Society of North America
|January 15, 2026
Summary
Pediatric both bone forearm fractures (BBFFs) with initial malunions up to 15° demonstrate significant remodeling potential. These fractures can heal without long-term functional deficits or affecting patient-reported outcomes.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Fracture healing
Background:
- Nonoperative management with closed reduction and immobilization is standard for pediatric both bone forearm fractures (BBFFs) meeting specific alignment criteria.
- A prior study identified asymptomatic pediatric patients with BBFFs that healed outside these parameters.
Purpose of the Study:
- To prospectively evaluate the long-term functional outcomes and remodeling potential of pediatric BBFFs with initial malunions exceeding standard criteria.
- To determine if significant malunion in pediatric BBFFs leads to long-term functional deficits or reduced quality of life.
Main Methods:
- A prospective study followed pediatric patients with healed BBFFs and initial sagittal or coronal angulation ≥15°.
- Patients underwent forearm radiographs, physical examinations, and completed the Pediatric Quality of Life Inventory (PedsQL) at minimum 2-year follow-up.
- Radiographic remodeling was assessed by comparing 2-year follow-up images to initial post-treatment images.
Main Results:
- Twenty-two patients with initial malunions ≥15° were followed for 2 years; none had residual angulation ≥15°.
- All patients exhibited functional range of motion, with no significant differences in most outcomes compared to those with normal pronation or within PedsQL norms.
- Six patients (27%) scored below 1 standard deviation on PedsQL, but this did not correlate with other outcome variables or range of motion deficits.
Conclusions:
- Pediatric BBFFs with initial malunions ≥15° demonstrate substantial remodeling capacity by 2-year follow-up.
- These fractures can heal without significant long-term functional consequences or diminished patient-reported outcomes, suggesting current alignment recommendations may be re-evaluated.
- The findings support the potential for nonoperative management in a broader range of pediatric BBFFs.
More Related Videos
Related Concept Videos
01:27Fractures: Bone Repair
5.1K
Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
5.1K
01:09Changes in the Appendicular Skeleton with Age
3.4K
The upper and lower limb initially develops as a small bulge called a limb bud, which appears on the lateral side of the early embryo. The upper limb bud appears near the end of the fourth week of development, with the lower limb bud appearing shortly after.
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
3.4K
01:40Bone Remodeling
40.2K
Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
40.2K