Effect of radial bowing on pronation and supination in pediatric forearm diaphyseal fractures: comparison of dominant and nondominant arms

Pediatric forearm diaphyseal fractures are common and may require surgery to restore function. Radial bowing loss affects pronation-supination, but its impact on recovery and arm dominance remains unclear. This study aimed to evaluate the impact of radial bowing on pronation and supination limitations in the surgical treatment of pediatric forearm fractures and to investigate differences in outcomes between fractures of the dominant and nondominant arms. Forty pediatric patients with diaphyseal forearm fractures underwent surgical treatment. Pronation-supination functions and radial bowing were assessed through maximal radial bowing (MRB) and maximal radial bowing localization (MRBL) values. Patients were divided into dominant and nondominant arm fracture groups, and functional outcomes were evaluated using the Price criteria. The MRB and MRBL values in the fractured arms were significantly lower than those in the intact arms (p < 0.001), highlighting reduced radial bowing postfracture. While no significant relationship was found between MRB-MRBL and functional outcomes in children ≤ 9 years of age, this relationship became significant in children > 9 years of age. Pronation and supination limitations were more pronounced in nondominant arm fractures than in dominant arm fractures, where functional adaptation appeared to be better. Radial bowing plays a critical role in preserving pronation and supination functions following pediatric forearm fractures. Maintaining radial bowing should be a primary surgical goal, particularly in patients over 9 years of age. Dominant arm fractures exhibit less functional restriction due to better adaptive capabilities, emphasizing the need for targeted rehabilitation, especially in nondominant arm fractures.