Biomechanical testing shows crossed pins and external fixation offer superior stability for pediatric supracondylar humerus fractures.

This study combined a systematic review with experimental biomechanical testing to evaluate fixation configurations for pediatric supracondylar humerus fractures. The setting involved a biomechanical laboratory and systematic review, though the specific population sample size and study phase were not reported. The primary outcomes assessed included stability, stiffness, and failure torque.

In biomechanical testing, a crossed metal pin configuration (L1M1) demonstrated superior rotational stability. Internal rotational stability was measured at 279.4 ± 24.8 Nmm/deg, while external rotational stability reached 336.0 ± 30.6 Nmm/deg. A network meta-analysis ranking across multiple parameters identified a configuration with two divergent lateral pins plus one medial pin (L2DM1) as consistently ranking highest. This configuration achieved SUCRA scores of 87.8% for external rotational stiffness, 100% for torsional failure torque, 99.7% for varus bending stiffness, and 92.9% for valgus bending stiffness.

Regarding specific stiffness parameters, external fixation demonstrated the highest performance. SUCRA scores for external fixation were 85.7% for internal rotational stiffness and 96.1% for extension bending stiffness. Additionally, bioabsorbable pins were found to exhibit significantly reduced strength compared to other materials, though specific quantitative data were not reported. No adverse events, serious adverse events, discontinuations, or tolerability data were reported in this biomechanical study.

Key limitations include the exclusive reliance on biomechanical data, meaning no clinical outcomes or causality were established. The study population details and sample size were not reported. Consequently, these biomechanical findings should serve as adjunctive evidence to complement clinical outcome data in guiding optimal treatment selection. Clinicians must interpret these results cautiously, recognizing that mechanical superiority does not automatically translate to improved patient outcomes or safety in a clinical setting.