Plastic Deformation of the Pediatric Forearm: Recognition, Radiographic Measurement, and Management

Pediatric forearm bowing fractures, also known as plastic deformation fractures, are a clinically important but often underdiagnosed injury pattern. These fractures usually occur from longitudinal compressive forces, such as falls on an outstretched hand, causing plastic deformation that exceeds the elastic limit of pediatric bone. Patients often present with nonspecific symptoms like pain, swelling, and limited pronation-supination, and these injuries can be subtle on radiographs. Using standardized measurement methods, such as the percentage of radial bowing relative to total bone length, can improve diagnosis; values over approximately 10% of radial length are considered suggestive of pathological bowing. Missing or delaying diagnosis can lead to persistent deformity, limited forearm rotation, malunion, and long-term functional impairments. The purpose of this review is to synthesize and critically evaluate current literature on pediatric forearm bowing fractures, focusing on their pathophysiology, injury mechanisms, clinical presentation, diagnostic challenges, imaging options, measurement techniques, treatment strategies, and outcomes. Key Concepts: 1. Pediatric forearm bowing fractures are subtle plastic deformation injuries that are often underdiagnosed because of minimal radiographic evidence. 2. Unique biomechanical properties of pediatric bone allow deformation without cortical disruption, which can increase the risk of missed diagnoses. 3. Standardized radiographic measurements and awareness of normative bowing values enhance diagnostic accuracy. 4. Early identification and suitable management are essential to prevent long-term deformity and loss of forearm rotation.