Background <p>Few studies have investigated the contributing factors for pediatric radial neck fractures. This study aimed to analyze the radiographic and clinical factors that influence the treatment outcomes in pediatric radial neck fracture.</p> Methods <p>This retrospective study included the 112 pediatric patients with radial neck fracture. On elbow radiographs, angulation, displacement, and carrying angle were measured, and fractures were classified using the modified Judet classification. Clinical outcomes were assessed using the Flynn criteria based on the elbow ROM and carrying angle. Univariable and multivariable Firth logistic regression analysis was used to assess the risk factors for unsatisfactory clinical outcome.</p> Results <p>According to the Flynn criteria, 99 (88.4%) and 13 (11.6%) patients had satisfactory (excellent or good) and unsatisfactory (fair or poor) outcomes, respectively. There were statistically significant differences in the initial displacement and follow-up duration between the two groups (<i>p</i> = 0.002 and 0.025, respectively). Multivariable Firth logistic regression analysis showed that initial displacement was the only independent risk factor for unsatisfactory clinical outcomes after pediatric RNF (odds ratio = 1.448, <i>p</i> = 0.002). The cutoff value of displacement for predicting unsatisfactory clinical outcomes was 72% with a 53.9% of sensitivity and an 87.9% of specificity.</p> Conclusions <p>This study showed that greater initial displacement was associated with an increased risk of unsatisfactory clinical outcomes in pediatric radial neck fractures. The exploratory 72% displacement threshold may help identify higher-risk patients; however, further validation is required before clinical application.</p>