# Sex-Based Anatomical Variations and Complication Risks in Pediatric Both-Bone Forearm Fractures: A Level of Evidence IV Retrospective Analysis

## TL;DR

Boys with forearm fractures have anatomical differences that lead to more unstable fractures and higher surgical rates compared to girls.

## Contribution

This study identifies sex-based anatomical differences in pediatric forearm fractures and their impact on surgical intervention rates.

## Key findings

- Boys had greater initial radius angulation and longer forearm bones than girls.
- Surgical intervention was required in 15.5% of boys but none of the girls.
- Overall complication rates did not differ significantly between sexes.

## Abstract

What are the main findings?
The study demonstrated that boys with both-bone forearm fractures had greater initial radius angulation and longer forearm bones compared to girls. Surgical intervention was required only in boys, whereas overall complication rates did not differ significantly between sexes.

The study demonstrated that boys with both-bone forearm fractures had greater initial radius angulation and longer forearm bones compared to girls. Surgical intervention was required only in boys, whereas overall complication rates did not differ significantly between sexes.

What is the implication of the main finding?
These results indicate that male-specific anatomical characteristics predispose boys to unstable fracture patterns and a higher likelihood of surgical treatment. Considering sex-based anatomical differences in treatment planning may improve early risk stratification and guide timely surgical decisions.

These results indicate that male-specific anatomical characteristics predispose boys to unstable fracture patterns and a higher likelihood of surgical treatment. Considering sex-based anatomical differences in treatment planning may improve early risk stratification and guide timely surgical decisions.

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.