Biomechanical Optimization of Pediatric Supracondylar Humerus Fracture Fixation: Insights from an Experimental Study and Network Meta-analysis

Wei-Han Lin¹, Pei-Chun Lai², Yu-Kang Tu³, Ming-Tung Huang⁴, Chii-Jeng Lin⁵, Che-Wei Lin⁶, Ching-Ju Fang⁷, Po-Ting Wu⁸, Wei-Ren Su⁹, Ming-Long Yeh⁶, Fa-Chuan Kuan⁴, Kai-Lan Hsu⁴, Chih-Kai Hong⁴, Su-Ying Lee¹⁰, Chien-An Shih¹¹

Affiliations

¹ School of Medicine, National Cheng Kung University, Tainan, Taiwan; Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedics, Show Chwan Memorial Hospital, Changhua, Taiwan.
⁶ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Library, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
¹⁰ Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹¹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: sam5214330@hotmail.com.

PMID: 41076056
DOI: 10.1016/j.jse.2025.08.021

Biomechanical Optimization of Pediatric Supracondylar Humerus Fracture Fixation: Insights from an Experimental Study and Network Meta-analysis

Wei-Han Lin et al. J Shoulder Elbow Surg. 2025.

. 2025 Oct 9:S1058-2746(25)00706-2.

doi: 10.1016/j.jse.2025.08.021. Online ahead of print.

Authors

Affiliations

¹ School of Medicine, National Cheng Kung University, Tainan, Taiwan; Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedics, Show Chwan Memorial Hospital, Changhua, Taiwan.
⁶ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
⁷ Department of Secretariat, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Library, National Cheng Kung University, Tainan, Taiwan.
⁸ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan; Department of Orthopedics, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
¹⁰ Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹¹ Department of Orthopedics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: sam5214330@hotmail.com.

PMID: 41076056
DOI: 10.1016/j.jse.2025.08.021

Abstract

Background: To comprehensively evaluate the biomechanical properties of traditional and emerging fixation configurations for pediatric supracondylar humerus fractures through experimental testing and network meta-analysis (NMA).

Methods: The study consisted of two parts: (1) A biomechanical comparison of five fixation configurations: two divergent lateral metal pins (L2D), two divergent lateral bioabsorbable pins (L2D-B), two divergent lateral pins with supplementary lock wire (L2D-W), crossed metal pins (L1M1), and crossed bioabsorbable pins (L1M1-B). Specimens underwent cyclic loading in multiple directions followed by load-to-failure testing. (2) A NMA of 12 published biomechanical studies comparing different fixation methods for supracondylar fractures.

Results: In biomechanical testing, crossed metal pin configuration (L1M1) demonstrated superior rotational stability (internal: 279.4±24.8 Nmm/deg; external: 336.0±30.6 Nmm/deg) compared to other configurations. The NMA revealed that two divergent lateral pins plus one medial pin (L2DM1) consistently ranked highest across multiple biomechanical parameters: external rotational stiffness (SUCRA=87.8%), torsional failure torque (SUCRA=100%), varus bending stiffness (SUCRA=99.7%), and valgus bending stiffness (SUCRA=92.9%). External fixation demonstrated the highest performance for internal rotational stiffness (SUCRA=85.7%) and extension bending stiffness (SUCRA=96.1%).

Conclusion: This biomechanical analysis demonstrates that crossed pin configurations and external fixation provide superior mechanical stability, while wire-augmented lateral pins offer promising alternatives. Bioabsorbable pins exhibit significantly reduced strength. These biomechanical findings should serve as adjunctive evidence to complement clinical outcome data in guiding optimal treatment selection for pediatric supracondylar humeral fractures.

Keywords: Biomechanical Analysis; Network Meta-analysis; Pediatric Fracture; Pin Fixation; Supracondylar Humerus Fracture.

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Biomechanical Optimization of Pediatric Supracondylar Humerus Fracture Fixation: Insights from an Experimental Study and Network Meta-analysis

Affiliations

Biomechanical Optimization of Pediatric Supracondylar Humerus Fracture Fixation: Insights from an Experimental Study and Network Meta-analysis

Authors

Affiliations

Abstract

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