Modernizing preoperative planning in orthopaedic trauma surgery

Preoperative planning in orthopaedic trauma remains largely experience-driven despite advances in imaging and predictive modeling. Although three-dimensional (3D) reconstructions improve fracture visualization, they do not routinely predict biomechanical stability across competing fixation strategies. Automated segmentation and finite element analysis (FEA) offer the potential to transition trauma planning from primarily anatomic to a method by which constructs may be optimized. This narrative review summarizes the current state of 3D planning and segmentation, describes the principles and established applications of FEA, delineates the workflow of finite element modeling in clinical practice, and integrates representative clinical cases to illustrate how plate positioning and screw configuration affect construct stability and works alongside the surgeon to help inform decisions. Broader implications for hospital systems, patients, and industry are discussed, along with future integration into navigation, robotics, and intraoperative 3D imaging workflows.