Traditional operative management of unstable, pediatric both-bone forearm fractures is fixation of both ulna and radius. Literature suggests single-bone fixation with intramedullary nailing obtains good results and is less technically demanding and invasive. This systematic review evaluates the efficacy of single-bone intramedullary nailing of pediatric both-bone forearm fractures. Medline and Embase were searched for English-language primary studies published in peer-reviewed journals. Two independent investigators extracted data. Eleven papers met the criteria for inclusion. Overall, studies found pronation and supination and radiographic angulation outcomes were comparable in single and both-bone fixation cohorts. Rates of pronation and supination loss and re-angulation were similar for radius-only compared to ulna-only fixation.