Vitamin D Status, Supplementation and Radiographic Healing in Pediatric Both-Bone Forearm Fractures: A Prospective Controlled Study

BACKGROUND: Vitamin D plays an essential role in skeletal mineralization and fracture repair, yet its influence on fracture healing in children remains incompletely understood. The aim of this study was to evaluate the relationship between vitamin D status, fracture occurrence, radiographic healing progression, and different supplementation protocols in pediatric both-bone forearm fractures. METHODS: This prospective controlled study included 151 children aged 5-12 years with conservatively treated both-bone forearm shaft fractures and 140 healthy age-matched controls. Baseline serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured in all participants. Fracture patients with suboptimal vitamin D levels (<30 ng/mL) received either standard-dose (1000 IU/d, n=109) or high-dose (2000 IU/d, n=33) oral cholecalciferol for 12 weeks. Fracture healing was assessed radiographically using serial modified Radiographic Union Score for Tibial fractures (mRUST) measurements obtained at 4, 6, and 12 weeks. RESULTS: Mean baseline vitamin D levels were similar between fracture and control groups (13.96±7.85 vs. 15.46±6.91 ng/mL, P=0.086), although severe vitamin D deficiency was significantly more prevalent in fracture patients (25.2% vs. 8.6%, P<0.001). Patients with vitamin D levels <20 ng/mL demonstrated significantly lower 12-week union rates compared with patients with levels ≥20 ng/mL (48.9% vs. 80.3%, P<0.001). High-dose supplementation was associated with significantly higher union rates (78.8% vs. 57.8%, P=0.029) and higher final mRUST scores (13.82±1.41 vs. 12.96±1.87, P=0.016). Baseline vitamin D concentration independently predicted fracture union (OR=1.15, P<0.001). CONCLUSION: Vitamin D status appears to influence fracture healing progression in pediatric forearm fractures. Lower vitamin D levels were associated with delayed radiographic healing, while higher-dose supplementation was associated with more favorable healing outcomes. Early identification and correction of vitamin D deficiency may represent a potentially modifiable factor in optimizing pediatric fracture healing. LEVEL OF EVIDENCE: Level III, -prospective comparative therapeutic study.