Biomechanical Stability of Tibia Plateau Fracture Treatment: Conventional vs. Finite Element-Based Preoperative...

Tibial plateau fractures are complex injuries requiring anatomical reduction and stable fixation to restore joint congruency and function. Digital tools, including CT reconstructions, computer-assisted implant planning, and finite element (FE) modeling, have the potential to improve fixation strategies. This experimental study investigated whether FE-based preoperative planning enhances the stability of tibial plateau fracture fixation compared with conventional planning, assessing construct stiffness, load to failure, and fracture stability under physiologic loading. Twelve human cadaveric lower limbs (78 ± 10 years) with induced Schatzker IV fractures were randomized to conventional (n = 6) or FE-based planning (n = 6). In the FE group, fragment reduction, screw trajectories, and implant positioning were optimized via computational modeling and guided intraoperatively by individual targeting guides. Conventional planning used standard CT visualization. All specimens were fixed using a medial locking plate and tested under axial loading, including stiffness measurement and progressively increasing cyclic loading until failure. Plate and screw positioning did not clearly differ between approaches, however FE-based planning promoted more consistent locking screw utilization and more frequent individual screw usage. FE-based planning yielded higher load to failure (1050 ± 535 N vs. 442 ± 226 N, p = 0.041), more cycles to failure (10,100 ± 5400 vs. 4100 ± 2400; p = 0.046), and more symmetrical construct stiffness. After adjustment for anatomical variations, differences in failure load were no longer statistically significant. Tibial plateau widening during loading was comparable between groups. These findings suggest that FE-based planning can enhance construct stability and reduce fixation asymmetry. Further clinical validation is needed to determine whether these benefits translate into improved outcomes.