{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:01Z","timestamp":1788243361592,"version":"build-2803163510"},"reference-count":13,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T00:00:00Z","timestamp":1788048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Elastic stable intramedullary nailing (ESIN) is widely used for the treatment of pediatric diaphyseal forearm fractures. Although fracture union is commonly achieved, restoration of physiological radial bowing is essential for optimal forearm biomechanics. Most previous studies have focused on bowing magnitude, whereas the anatomical location of maximal radial bowing has received limited attention. Methods: This retrospective observational study included pediatric patients aged 4\u201316 years who underwent ESIN for diaphyseal radius and ulna fractures and had a minimum follow-up of 1 year. Postoperative anteroposterior radiographs were analyzed to determine maximal radial bowing (MRB) and the location of maximal radial bowing (LMRB) using standardized radiographic methods. Simultaneous concordance with the literature-derived MRB (6\u20139%) and LMRB (55\u201375%) reference ranges was evaluated as an exploratory composite radiographic outcome. Clinical, radiological, and surgical variables were analyzed, and multivariable logistic regression was performed to identify factors associated with the exploratory composite radiographic outcome. Results: A total of 61 patients were included. The mean age was 10.8 \u00b1 2.6 years, and 86.9% were male. Mean MRB was 5.9 \u00b1 0.9%. MRB and LMRB were within the predefined literature-derived reference ranges in 55.7% and 85.2% of patients, respectively, and simultaneous concordance with both ranges was observed in 50.8%. A significant association was identified between MRB and LMRB, indicating that increased bowing magnitude was associated with a more proximally located maximal bow. The injury-to-surgery interval was not independently associated with the exploratory composite radiographic outcome. Despite radiological variability, 95.1% of patients demonstrated excellent or good functional outcomes. Conclusions: In this retrospective cohort, combined evaluation of MRB and LMRB provided a descriptive assessment of postoperative radial alignment. Concordance with both predefined reference ranges was associated with less supination loss; however, no individual radiographic parameter showed a significant correlation with functional outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176743","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6743","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Restoration of Radial Bowing After Elastic Stable Intramedullary Nailing in Pediatric Forearm Fractures: The Importance of Bowing Location in Addition to Magnitude"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0049-7937","authenticated-orcid":false,"given":"Osman G\u00f6rkem","family":"Murato\u011flu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Atlas University Faculty of Medicine, Atlas University Hospital, Istanbul 34203, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Hasan","family":"Ceylan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Atlas University Faculty of Medicine, Atlas University Hospital, Istanbul 34203, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"}]},{"given":"G\u00f6khan","family":"G\u00fczel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Atlas University Faculty of Medicine, Atlas University Hospital, Istanbul 34203, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1770-0276","authenticated-orcid":false,"given":"Fatih","family":"G\u00fcnayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Mersin City Hospital, Mersin 33240, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fevzi Mehmet","family":"Kuyumcu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Cam and Sakura City Hospital, Istanbul 34480, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Mehmet Ali","family":"Talma\u00e7","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Cam and Sakura City Hospital, Istanbul 34480, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Cem","family":"Y\u0131ld\u0131r\u0131m","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Atlas University Faculty of Medicine, Atlas University Hospital, Istanbul 34203, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1097\/BPB.0000000000000162","article-title":"The Shaft Fractures of the Radius and Ulna in Children: Current Concepts","volume":"24","author":"Sinikumpu","year":"2015","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1016\/j.injury.2004.12.010","article-title":"State-of-the-Art Treatment of Forearm Shaft Fractures","volume":"36","author":"Schmittenbecher","year":"2005","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1302\/0301-620X.86B7.14294","article-title":"Measurement of Bowing of the Radius","volume":"86-B","author":"Firl","year":"2004","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.2106\/00004623-199274070-00014","article-title":"The Effect of Malunion on Functional Outcome after Plate Fixation of Fractures of Both Bones of the Forearm in Adults","volume":"74","author":"Schemitsch","year":"1992","journal-title":"J. Bone Jt. Surg. 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The Development of the Radial Bow in Children: Normative Values. Children, 12.","DOI":"10.3390\/children12010101"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11832-011-0379-6","article-title":"Functional Outcome Following Intramedullary Nailing or Plate and Screw Fixation of Paediatric Diaphyseal Forearm Fractures: A Systematic Review","volume":"6","author":"Westacott","year":"2012","journal-title":"J. Child. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1016\/j.jseint.2025.04.023","article-title":"How Does a Reduction in the Radial Bow, in Addition to a Rotational Deformity of the Radius, Affect the Range of Motion of the Forearm: An Anatomical Cadaver Study","volume":"9","author":"Metoki","year":"2025","journal-title":"JSES Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/01.bpo.0000235397.64783.d6","article-title":"Use and Abuse of Flexible Intramedullary Nailing in Children and Adolescents","volume":"26","author":"Lascombes","year":"2006","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1302\/0301-620X.86B7.15273","article-title":"Flexible Intramedullary Nails for Fractures in Children","volume":"86-B","author":"Barry","year":"2004","journal-title":"J. Bone Jt. Surgery. Br."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Gundogdu, K., Alaca, O., and Soyucok, A. (2025). Effect of Radial Bowing on Pronation and Supination in Pediatric Forearm Diaphyseal Fractures: Comparison of Dominant and Nondominant Arms. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-025-09423-z"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6743\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:56:17Z","timestamp":1788242177000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6743"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,30]]},"references-count":13,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176743"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176743","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,30]]}}}