Objective: Radial physeal fractures are the most common growth plate injuries in children. While most are treated nonoperatively, some cases require surgical intervention due to initial displacement or loss of reduction. Individual biomechanical factors such as radial bowing and obesity-related soft-tissue mass may influence fracture stability but remain underexplored. This study aimed to assess whether increased radial bowing and body mass index (BMI) are associated with a higher risk of requiring surgical treatment in pediatric radial epiphyseal fractures.
Materials and
Methods: In this retrospective observational study, 106 children aged 2–16 years with isolated proximal or distal radial epiphyseal fractures were analyzed. Radiographic parameters, including radial bowing (percentage and location) and soft-tissue-to-bone ratio (SKYO), were measured on the contralateral intact forearm. BMI percentiles were calculated, and fracture characteristics were recorded. The primary outcome was the need for surgical treatment; secondary outcomes included re-reduction rates and associations between anatomical variables and treatment approach. Statistical analyses included Student’s t-tests and Spearman correlation.

Results: Of 106 patients (63.2% male; mean age: 10.2 years), only 2 (1.9%) underwent surgery. The mean radial bowing was 6.24% (range: 4.4–8.71), with an average bowing location at 61.2% of radial length. Mean SKYO was 33.1%, and average BMI percentile was 68.67. No significant relationship was found between radial bowing, SKYO, or BMI and the need for surgery. A positive correlation was observed between radial bowing and SKYO (p=0.032), and an inverse correlation between BMI percentile and SKYO (p=0.041).

Conclusion: Radial bowing and soft-tissue thickness (SKYO), although anatomically variable, were not predictive of surgical need in pediatric radial epiphyseal fractures. Nearly all cases were effectively managed conservatively, with excellent functional outcomes. These findings suggest that individual anatomical variation, including radial bowing and BMI, should not influence initial surgical decision-making in physeal fractures of the radius.