A Comparative Biomechanical Analysis of Two Dissimilar Fixation Constructs for Posterolateral Tibial Plateau Fractures

A Comparative Biomechanical Analysis of Two Dissimilar Fixation Constructs for Posterolateral Tibial Plateau Fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Comparative Biomechanical Analysis of Two Dissimilar Fixation Constructs for Posterolateral Tibial Plateau Fractures Wei Weng, Hang-Bin Pan, Hai-Jie Ke, Zhan-Feng Zhang, Shu-Feng Huang, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7976233/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 19 You are reading this latest preprint version Abstract Background: The management of posterolateral tibial plateau fractures is mainly done by stable fixation which facilitates early mobility. Anterolateral locking plate (ALP) fixation and posterolateral locking plate (PLP) fixation are two commonly used fixation methods in clinical. This investigation’s aim was to examine the posterolateral tibial plateau biomechanical properties via arithmetical modeling and to quantify their effects on the fracture reconstruction. Methods: Two different 3D posterolateral tibial plateau fracture finite element models with the ALP and PLP fixation were created. The daily life axial compressive load on a typical adult knee was simulated using diversified axial forces (250N 500N 750N and 1000N). The comparable maps of displacement, stress and relative displacement were analyzed and quantified along the fracture lines. Results: The comparable Von Mises Stress (EVMS) stresses and comparable displacement changes in the fixations were elevated and associated with axial force. However, under the same axial force, the EVMS of the PLP fixation system is smaller than that of the ALP fixation system. The concentration region of stress in two fixation systems is also different, which appears at point C in ALP fixation system and point A in PLP fixation system respectively. Under the same axial force, the displacement changes of the A-B-C-D point on ALP fixation system is larger than that on PLP fixation system, but there is no significant difference in equivalent strain at each point. Conclusions: The computed results of stress of the fracture models show that the posterolateral locking plate (PLP) fixation system can provided a better biomechanical stability than the anterolateral locking plate (ALP) fixation system in treatment of posterolateral tibia fracture although their internal stress distribution was differed. However, if the equivalent displacement is also taken into account, the ALP and PLP fixation system had similar ability to resistant deformation. Tibial plateau Posterolateral fracture Internal fixation Finite element Figures Figure 1 Figure 2 Figure 3 Introduction In recent years, with rapid development of imaging technology, isolated or multiple posterolateral tibial plateau fractures are now common [1-2]. The treatment for posterolateral tibial plateau fracture remains controversial. Most authors advocate for open reduction internal plate fixation (ORIF) as the optimal treatment method whereas other authors suggest other alternative methods [3-4]. The posterolateral column fracture fixation that utilizes a locking screw plate is more mechanically stable than other fixation techniques [5]. Anterolateral supra-fibular-head approach gives direct visuals of the posterolateral tibial plateau quadrant and it places the plate more dorsal to provide a raft for the fragments for better management. Although this surgical approach is widely used, its biomechanical stability has not been evaluated in the literature [6]. Finite element analysis is widely used in orthopedics research to quantify the fracture displacement as well as the load distributions in either simulated surgical transplants or adjacent bones [7,8]. At present, the anterolateral locking plate (ALP) fixation and posterolateral locking plate (PLP) fixation method for the posterolateral tibial plateau fractures are most widely used. The posterolateral T-shaped plate using three parallel locking screws compared with the anterolateral L-shape plate using two parallel locking screws, whether there are differences in biomechanical stability has not been reported yet. In the current study, the FEA investigated whether the two dissimilar plates could sufficiently provide fixation strength for posterolateral tibial plateau fracture and their biomechanical properties when they are both used. Methods The 3-dimensional (3-D) nonlinear FE model for the tibial plateau was derived from a 32-year-old healthy adult man’s computed tomography (CT) scan, who had a height of 170 cm and body weight of 60 kg. The construction of the 3D model was done through Digital Imaging and Communications in Medicine (DICOM) setup using Mimics software (v15.0, Materialize Company, Leuven, Belgium) and the results were exported into Geomagic Studio Software (v2014, 3D system Inc., Rock Hill, SC, USA) for perfecting and levelling the surface. Fracture models simulating posterolateral fractures according to Luo’s study were created for biomechanical testing [9]. The transverse plane of the tibial plateau’s articular surface on CT scan was defined as the typical measurement plane. Labels were given as follows; (a) the maximum anteroposterior diameter (APD) of the posterolateral fragment and (b) the maximum APD of the lateral tibial plateau; their area combined to a 1/3 of articular surface. The a and b sides were used to construct a rectangle and a horizontal line was constructed on the lateral side posterior 1/3 (Point A) while a vertical line was constructed on the lateral side posterior 1/3 (Point B), Point C was named at the point these two lines intersect. Lastly, a straight line was drawn through point C, which is at an angle of 120° to the straight-line AC. The posterolateral fragment’s sagittal angle was nearly 80°. The length of the cortical division on the coronal plane (length from the edge of the joint to the distal tip) was approximately 30 mm. There were two different fixation models, anterolateral locking plate (ALP) fixation system with two 3.5-mm cortical parallel screws and posterolateral locking plate (PLP) fixation system with three 3.5-mm cortical crossed screws. The STEP arrangement of the 3D models was set aside. All the 3D finite element models of the posterolateral tibial plateau fractures were fixed by two different fixation implants which the characteristics shown in Fig. 1. Afterward, the finite element models were exported to ABAQUS software (v6.16, SIMULIA Inc., Providence, RI, USA) and it initiated the analysis. The relative displacement was quantified along the fracture lines and the displacement of different axes exhibited some forms of alignment. The positive directions of Z, Y, and X axes were from right to left, anterior to posterior and distal to proximal. Because the posterolateral fracture of the tibial plateau is mainly collapse fracture, this study only calculates the relative displacement and stress distribution in the Z-axis direction. We set the Z-axis direction perpendicular to the direction of the posterolateral tibial plateau. Four different axial loading forces parallel to the Z axis (250N 500N 750N 1000N) were performed on the fracture model, while the distal end was fixed effectively. In Abaqus software, on the upper surface of the fracture block, node coupling is used, and the surface is coupled to the geometric center point position, and then four different forces were loaded at this point. The equivalent von Mises stress (EVMS) and relative displacement of the model were used as the output measures for analysis. Material properties In current study, the tibia and fibula bones were defined as linear elastic material properties with cortical bone having a Young’s modulus (E) of 17 GPa whilst the cancellous bone has 5 GPa. The Poisson’s ratio (y) for both cortical and cancellous bones had a standardized value of 0.33 [10]. The titanium alloy for constructing simulated bone implants had a Young’s modulus of 110 GPa and Poisson’s ratio of 0.3 s. The bones, metals and all other materials were assumed to be similar and linear isotropic to avoid artificially distinguishing their boundaries. Their contact surfaces amidst the plates and screws were assumed to be similar to real ones [11]. Tetrahedral tennode elements (C3D4) meshed all components within the FE models. The data concerning the nodes and elements are shown in Table 1. Results The stress on 2 fixation systems The ALP fixation method had a stress distribution which differed from that of the PLP fixation method. Under the four different axial forces of 250N 500N 750N 1000N the maximum equivalent stresses of the ALP fixation method and the PLP method are different, which are 12.08, 24.16, 36.24, 48.31 MPa and 7.46, 14.91, 22.37, 29.82 MPa respectively manifesting that with the increase of axial load stress, the maximum equivalent stress increases gradually. However, under similar stress, the maximum equivalent stress of the PLP fixation method is less than that of the ALP method, which indicates a better biomechanical stability of the PLP fixation system. Besides, we also found that the stress distribution on each point in the fracture block is obviously different. The D-point bears the minimum stress in both models. In the ALP fixation model, the C-point bears the greatest stress compared with the other points. However, in the PLP fixation model, the A-point bears the greatest stress and is far greater than that of the ALP fixation model on the same point（Fig 2）. Equivalent displacement of two fracture models The equivalent displacement changes of the two fixation systems increase gradually with the increase of the axial force, which can be well reflected in the displacement change of A-B-C-D points. We also found that the equivalent displacement of those 4 points on the ALP fixation method is larger than that of the PLP fixation system while there was no significant difference in the equivalent strain of each point compared with the two models (Fig 3). What's more, the displacement changes at point A B C is more significant, while the displacement change at point D is the least obvious. (Table 2). When the axial force increases to 1000N, the maximum equivalent displacements of the ALP fixation system and the PLP fixation system are 0.66 and 0.78 mm respectively which are much lower than 2 mm, indicates that these two internal fixation methods can be regarded as stable fixation methods in clinical application. Discussion The posterolateral tibial plateau fracture is a rare type of fracture [12] and it is not fully explained in Schatzker or AO classification systems [13,14]. Although the 3- dimensional images are widely used, more orthopedic surgeons pay attention to fixation method of posterolateral tibial plateau fracture which are often caused by combining valgus and axial compressive forces when the knee joint is flexed, subsequently leading to the development of a fracture line. The fracture line is commonly found on the posterior surface of the bone’s coronal plane and is associated with complex multiple fractures with displaced fragments. This calls for surgical approaches that rebuild anatomical reduction and prevent secondary complications. Finite element (FE) analysis, examines the geometric properties and predicts the influence of specific factors in a given fixation [15-16], because it can focus on one factor at a time. As a result, FE analysis was used in this study to approximate 2 dissimilar fixation systems for fixing the posterolateral tibial plateau fracture. In this study, we used the raft theory for the ALP and PLP which produces a stable tibial plateau after ORIF. It has been demonstrated that amidst the apex of fibular head and lateral wall of plateau, there is enough space to allow the horizontal arm of the plate to pass through as well as the two parallel screws to insert into the posterolateral tibial fracture fragment. For the two-fixation system, stress distributions in both cases on tibial plateau, could not be examined by other mechanical methods. The results of the current study showed that the maximum displacement was less than 2 mm after using the 2 fixation methods under vertical pressure of 1000N. This was considered clinically relevant positive outcomes after the reduction of tibial plateau fracture [17]. In present study, we calculate the stress distribution on models through comparable von Mises stress (EVMS). The 2 fixation methods had majority of the stress forces located on the junction of the posterolateral tibial fracture block and the tibial shaft. In ALP fixation system, the concentration region of stress appears at point C, while in PLP fixation system the concentration region of stress appears at point A. They are all in the boundary area of the fracture block, farthest from the inner fixed body, and subjected to the maximum compressive deformation force manifesting that these two regions influenced the load transmitted from the articular surface [18]. The motion characteristics of the two models differed, also the distribution of the EVMS inner of the fracture model is different, but both increase with the increase of the axial load. When the axial force applied to 1000N, the maximum equivalent stress of the ALP fixation system is 48.31 MPa, and the maximum equivalent stress of the PLP fixation system is 29.82 MPa, which indicates that the stability of the PLP fixation system is better than that of the ALP fixation system. This may be due to the fact that the T-plate provides a larger cross-sectional area on the upper surface of the tibial plateau than the L-shaped plate so the PLP fixation system provided high stability than ALP fixation system which can help in the early mobilizing step of weight bearing [19-20]. When the stress force was compared to maximum resistance of the simulated materials resulting in the maximum von Mises stress of 48.31MPa, which was lesser than the maximum resistance of 795MPa (titanium alloy) [21]. There was no evidence mechanical screw damage, plate damage or bending. In present study, under the same axial force, the relative displacement of the A B C D point on the ALP fixation system is larger than that on the PLP fixation system, but there is no significant difference in equivalent strain at each point. This may be related to the difference between the two fixation methods. Compared with the ALP fixation system with two parallel screws, the PLP fixation system with three parallel screws provides a larger cross-sectional area that have a larger contact area between the screws and the fracture block, and are less prone to deformation [22]. The point A B C on the fracture model are located on the surface of the tibial plateau, and the point D is located below the tibial plateau. When the axial force is applied, the surface of the tibial plateau is subjected to the maximum stress, resulting in the most significant change in the displacement of the A B C point while the stress at point D is the smallest due to displacement is the least obvious. Although the PLP fixation system is widely used in clinical practice due to its good mechanical stability, but this approach may result in delayed fracture healing due to vascular nerve injury due to large incisions [23]. Therefore, the anterolateral plate (ALP) fixation system can greatly reduce the operation time and reduce the risk of vascular nerve injury probably is a suitable method for patients who has the requirement of early weight bearing. Limitations The limitations included; stimulated cortical and cancellous bone materials were not exactly similar to the actual bone conditions. We were not able to simulate soft tissues, menisci and cartilage to surround the bones. The models were focused on stationary loading rather than dynamic loading because it requires highly skilled computer resources. This study only focused on axial loads. However, axial load is very vital because it is the cause of most fixation errors. Conclusion In summary, the posterolateral plate (PLP) fixation system can provided a better biomechanical stability than the anterolateral plate (ALP) fixation system in treatment of posterolateral tibia fracture though it may bring greater deformation. However, when it is necessary to consider the factors of the surgery itself, the orthopedic surgeon can choose a reasonable surgical method according to his own preferences and patient needs, as well as surgical complications. Abbreviations FE: Finite Element; CT: Computed Tomography; EVMS: equivalent Von Mises Stress; APD: anteroposterior diameter; ALP: anterolateral plate; PLP: posterolateral plate Declarations Acknowledgments We thank Dr. Sheng-di Ding for providing linguistic assistance during the preparation of this manuscript. Authors' contributions Dr. SdD, WW and Dr. ZfZ established fracture model, and Dr. HbP , HjK, SfH analyzed and interpreted the patient data regarding the biomechanical test. Dr.WW and Dr. SdD ,StX were a major contributor in writing the manuscript. Dr. HbP and WW contributed equally to this work. All authors read and approved the final manuscript. Funding This study was supported by Zhejiang Province Public Welfare Technology Application Research Project (CN), China (Grant No. LGF20H060009). Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate All procedures were performed in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of The First Hospital of Huzhou (approval number: 2019035). The ethics committee of the The First Hospital of Huzhou waived the need for informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 Department of Orthopedics, The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Huzhou, Zhejiang Province, 313000. China 2 Huzhou Central Hospital, Huzhou Central Hospital of Zhejiang University, NO. 1558 Sanhuanbei Road, Huzhou, Zhejiang Province, 313000, China. References Urruela AM, Davidovitch R, Karia R, Khurana S, Egol KA. Results following operative treatment of tibial plateau fractures. J Knee Surg. 2013; 26:161-5. Qi-fang He, Hui Sun, et al. Tibial plateau fractures in elderly people: an institutional retrospective study. Journal of Orthopaedic Surgery and Research. 2018; 13:276. Berber R, Lewis CP, Copas D, Forward DP, Moran CG. Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury. 2014; 45:757–65. Liu C D , Hu S J , Chang S M ,et al.Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy[J].International Journal of Surgery, 2025, 111(1):12. Carrera I, Gelber PE, Chary G, Gonzalez-Ballester MA, Monllau JC, Noailly J. Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. Int Orthop. 2016;40(10):2163–69. Hu S J, Chang S M, Zhang Y Q, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique[J]. Injury, 2015, 47(2):502-507. Massey P A , Scalisi W , Duval C ,et al.Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating[J].JBJS Open Access, 2025, 10(1). Jordan M C , Zimmermann C , Gho S A , et al. Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures[J]. BMC Musculoskeletal Disorders, 2016, 17(1):287. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010; 24:683–92. Luo CA, Hua SY, Lin SC, Chen CM, Tseng CS. Stress and stability comparison between different systems for high tibial osteotomies. BMC Musculoskelet Disord. 2013; 14:110. Chen F, Huang X, Ya Y, et al. Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures[J]. Journal of Orthopaedic Surgery and Research, 2018, 13(1):12. Elsoe R, Larsen P, Nielsen NP, Swenne J, Rasmussen S, Ostgaard SE. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38(9): 780–6. Ter Meulen DP, Janssen SJ, Hageman MG, Ring DC. Quantitative three- dimensional computed tomography analysis of glenoid fracture patterns according to the AO/OTA classification. J Shoulder Elb Surg. 2016;25(2):269–75. Zhang, W. et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. The Knee. 2012; 19, 94–8. Chen P, Lu H, Shen H, Wang W, Ni B, Chen J. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study. J Orthop Surg Res. 2017;12(1):35. Kawabata Y, Matsuo K, Nezu Y, Kamiishi T, Inaba Y, Saito T. The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method. [J]. J Orthop Sci. 2017;22(5). Haller JM, O'Toole R, Graves M, Barei D, Gardner M, Kubiak E, Nascone J, Nork S, Presson AP, Higgins TF. How much articular displacement can be detected using fluoroscopy for tibial plateau fractures? Injury. 2015; 46:2243–7. Sassoon A A, Torchia M E, Cross W W, et al. Fibular Shaft Allograft Support of Posterior Joint Depression in Tibial Plateau Fractures[J]. Journal of Orthopaedic Trauma, 2014, 28(7): e169-e175. Prat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2016;1(5):225–32. Patil S, Mahon A, Green S, McMurtry I, Port A. A biomechanical study comparing a raft of 3.5 mm cortical screws with 6.5 mm cancellous screws in depressed tibial plateau fractures. Knee. 2006; 13:231–5. Carrera I, Gelber PE, Chary G, Gonzalez-Ballester MA, Monllau JC, Noailly J. Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. Int Orthop. 2016;40(10):2163–69. Epub 2016 Jan 16. Weimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: A biomechanical study[J]. BMC Musculoskeletal Disorders, 2013, 14(1):120. Wang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, Xu Y. Updated three-column 39. concept in surgical treatment for tibial plateau fractures -a prospective cohort study of 287 patients. Injury. 2016;47(7):1488–96. Tables Table 1. Parameters of the FE models Nodes/elements of ALP PLP Plate& Screws 4371/13635 3326/9516 Fragment 2165/7719 2434/8665 Tibia shaft 13188/53973 23990/100983 Table 2. Displacement changes of A B C D at each point on two fracture models. A B C D Max displacement (mm) ALP PLP ALP PLP ALP PLP ALP PLP 250N 0.0688157 0.0509008 0.0462476 0.0324038 0.0422082 0.0362376 0.0324058 0.0253227 500N 0.137627 0.101802 0.0924952 0.064795 0.0844168 0.0724763 0.0648116 0.0506452 750N 0.206437 0.152696 0.138743 0.0971874 0.126626 0.108715 0.0972174 0.0759676 1000N 0.275239 0.203586 0.18499 0.129581 0.168835 0.144954 0.129623 0.10129 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7976233","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":549170806,"identity":"a772dc85-5404-40dc-89c2-2a563c56ed06","order_by":0,"name":"Wei Weng","email":"","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Weng","suffix":""},{"id":549170807,"identity":"4ee10a67-ddf1-43ba-8a58-09997032e579","order_by":1,"name":"Hang-Bin Pan","email":"","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Hang-Bin","middleName":"","lastName":"Pan","suffix":""},{"id":549170808,"identity":"944655fd-42fa-4c42-a3b4-2444a479265e","order_by":2,"name":"Hai-Jie Ke","email":"","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Hai-Jie","middleName":"","lastName":"Ke","suffix":""},{"id":549170809,"identity":"1e25b899-4b05-44f8-8b0e-1463578bd552","order_by":3,"name":"Zhan-Feng Zhang","email":"","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Zhan-Feng","middleName":"","lastName":"Zhang","suffix":""},{"id":549170810,"identity":"d76163d4-529e-42e8-8af5-64851666e5b8","order_by":4,"name":"Shu-Feng Huang","email":"","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":false,"prefix":"","firstName":"Shu-Feng","middleName":"","lastName":"Huang","suffix":""},{"id":549170811,"identity":"648241a1-d1c5-4762-8562-343b4f84f097","order_by":5,"name":"Shi-Tong Xing","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYDACCTBpw8PP30CaljQZyRkHSNNy2MagIYFIHfKz2y9//PHnPI8BwwHGDx9ziNDCOOdMgTFv220ec+YGZsmZ24jQwiyRk5DM2HCbx7LhABszLzFa2IBaDv74c47H4EACkVp4JNIPNvCwHSBBi4TMGWZm3rZkHskZB5uJ8wswxB4DQ8zOnp+/+eCHj8RoATrNAMpgbCBKPRCwPyBW5SgYBaNgFIxUAABhGjTIW+FwtAAAAABJRU5ErkJggg==","orcid":"","institution":"The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University","correspondingAuthor":true,"prefix":"","firstName":"Shi-Tong","middleName":"","lastName":"Xing","suffix":""},{"id":549170812,"identity":"e56c9884-913e-4905-84dc-48fffb0e3a96","order_by":6,"name":"Sheng-Di Ding","email":"","orcid":"","institution":"Huzhou Central Hospital, Huzhou Central Hospital of Zhejiang University","correspondingAuthor":false,"prefix":"","firstName":"Sheng-Di","middleName":"","lastName":"Ding","suffix":""}],"badges":[],"createdAt":"2025-10-29 06:23:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7976233/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7976233/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96638244,"identity":"1be6e5e9-2c59-491d-9b95-836e3e7f25f4","added_by":"auto","created_at":"2025-11-24 13:57:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":3639046,"visible":true,"origin":"","legend":"\u003cp\u003eBrief introduction of the fracture models and the FE models. \u003cstrong\u003ea.\u003c/strong\u003e Fracture models.\u003cstrong\u003e b.\u003c/strong\u003e Finite element model of ALP + PLP with axial stress and bottom constraint. \u003cstrong\u003ec. \u003c/strong\u003eLoading area and screw fixing direction.\u003c/p\u003e","description":"","filename":"Fig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-7976233/v1/5de6c25288aaa1a33877dd44.png"},{"id":96638247,"identity":"192f8a27-f50d-4f24-9343-402cc9cb5a8a","added_by":"auto","created_at":"2025-11-24 13:57:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14460132,"visible":true,"origin":"","legend":"\u003cp\u003eStress distribution of two fixation models under different axial forces. Stress cloud diagram of ALP fracture model and PLP fracture model under four different axial forces of 250N 500N 750N 1000N.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7976233/v1/70c477d11dddc37ccfce7620.png"},{"id":96638246,"identity":"f6869ce4-1c1c-4017-a90f-cd680685b5bd","added_by":"auto","created_at":"2025-11-24 13:57:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":11700866,"visible":true,"origin":"","legend":"\u003cp\u003eDisplacement of two fracture models. Displacement cloud map of ALP fracture model and PLP fracture model under four different axial forces of 250N 500N 750N 1000N.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-7976233/v1/44ad32ee91518f5ca3376ca0.png"},{"id":97135538,"identity":"aa345b56-818d-4ae5-a000-06c5c8f1765c","added_by":"auto","created_at":"2025-12-01 09:50:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":33511398,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7976233/v1/6860c3e8-b0ff-4f26-9a75-930194d5e7e0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Comparative Biomechanical Analysis of Two Dissimilar Fixation Constructs for Posterolateral Tibial Plateau Fractures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, with rapid development of imaging technology, isolated or multiple posterolateral tibial plateau fractures are now common [1-2]. The treatment for posterolateral tibial plateau fracture remains controversial. Most authors advocate for open reduction internal plate fixation (ORIF) as the optimal treatment method whereas other authors suggest other alternative methods [3-4]. The posterolateral column fracture fixation that utilizes a locking screw plate is more mechanically stable than other fixation techniques [5]. Anterolateral supra-fibular-head approach gives direct visuals of the posterolateral tibial plateau quadrant and it places the plate more dorsal to provide a raft for the fragments for better management. Although this surgical approach is widely used, its biomechanical stability has not been evaluated in the literature [6].\u003c/p\u003e\n\u003cp\u003eFinite element analysis is widely used in orthopedics research to quantify the fracture displacement as well as the load distributions in either simulated surgical transplants or adjacent bones [7,8]. At present, the anterolateral locking plate (ALP) fixation and posterolateral locking plate (PLP) fixation method for the posterolateral tibial plateau fractures are most widely used. The posterolateral T-shaped plate using three parallel locking screws compared with the anterolateral L-shape plate using two parallel locking screws, whether there are differences in biomechanical stability has not been reported yet. In the current study, the FEA investigated whether the two dissimilar plates could sufficiently provide fixation strength for posterolateral tibial plateau fracture and their biomechanical properties when they are both used.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe 3-dimensional (3-D) nonlinear FE model for the tibial plateau was derived from a 32-year-old healthy adult man\u0026rsquo;s computed tomography (CT) scan, who had a height of 170 cm and body weight of 60 kg. The construction of the 3D model was done through Digital Imaging and Communications in Medicine (DICOM) setup using Mimics software (v15.0, Materialize Company, Leuven, Belgium) and the results were exported into Geomagic Studio Software (v2014, 3D system Inc., Rock Hill, SC, USA) for perfecting and levelling the surface.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFracture models simulating posterolateral fractures according to Luo\u0026rsquo;s study were created for biomechanical testing [9]. The transverse plane of the tibial plateau\u0026rsquo;s articular surface on CT scan was defined as the typical measurement plane. Labels were given as follows; (a) the maximum anteroposterior diameter (APD) of the posterolateral fragment and (b) the maximum APD of the lateral tibial plateau; their area combined to a 1/3 of articular surface. The a and b sides were used to construct a rectangle and a horizontal line was constructed on the lateral side posterior 1/3 (Point A) while a vertical line was constructed on the lateral side posterior 1/3 (Point B), Point C was named at the point these two lines intersect. Lastly, a straight line was drawn through point C, which is at an angle of 120\u0026deg; to the straight-line AC. The posterolateral fragment\u0026rsquo;s sagittal angle was nearly 80\u0026deg;. The length of the cortical division on the coronal plane (length from the edge of the joint to the distal tip) was approximately 30 mm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere were two different fixation models, anterolateral locking plate (ALP) fixation system with two 3.5-mm cortical parallel screws and posterolateral locking plate (PLP) fixation system with three 3.5-mm cortical crossed screws. The STEP arrangement of the 3D models was set aside. All the 3D finite element models of the posterolateral tibial plateau fractures were fixed by two different fixation implants which the characteristics shown in Fig. 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAfterward, the finite element models were exported to ABAQUS software (v6.16, SIMULIA Inc., Providence, RI, USA) and it initiated the analysis.\u0026nbsp;The relative displacement was quantified along the fracture lines and the displacement of different axes exhibited some forms of alignment. The positive directions of Z, Y, and X axes were from right to left, anterior to posterior and distal to proximal. Because the posterolateral fracture of the tibial plateau is mainly collapse fracture, this study only calculates the relative displacement and stress distribution in the Z-axis direction. We set the Z-axis direction perpendicular to the direction of the posterolateral tibial plateau.\u0026nbsp;Four different axial loading forces parallel to the Z axis (250N 500N 750N 1000N) were performed on the fracture model, while the distal end was fixed effectively. In Abaqus software, on the upper surface of the fracture block, node coupling is used, and the surface is coupled to the geometric center point position, and then four different forces were loaded at this point. The equivalent von Mises stress (EVMS) and relative displacement of the model were used as the output measures for analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial properties\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn current study, the tibia and fibula bones were defined as linear elastic material properties with cortical bone having a Young\u0026rsquo;s modulus (E) of 17 GPa whilst the cancellous bone has 5 GPa. The Poisson\u0026rsquo;s ratio (y) for both cortical and cancellous bones had a standardized value of 0.33 [10]. The titanium alloy for constructing simulated bone implants had a Young\u0026rsquo;s modulus of 110 GPa and Poisson\u0026rsquo;s ratio of 0.3 s. The bones, metals and all other materials were assumed to be similar and linear isotropic to avoid artificially distinguishing their boundaries. Their contact surfaces amidst the plates and screws were assumed to be similar to real ones [11]. Tetrahedral tennode elements (C3D4) meshed all components within the FE models. The data concerning the nodes and elements are shown in Table 1.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eThe stress on 2 fixation systems\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ALP fixation method had a stress distribution which differed from that of the PLP fixation method.\u0026nbsp;Under the four different axial forces of 250N 500N 750N 1000N the maximum equivalent stresses of the ALP fixation method and the PLP method are different, which are 12.08, 24.16, 36.24, 48.31 MPa and 7.46, 14.91, 22.37, 29.82 MPa respectively manifesting that with the increase of axial load stress, the maximum equivalent stress increases gradually. However, under similar stress, the maximum equivalent stress of the PLP fixation method is less than that of the ALP method, which indicates a better biomechanical stability of the PLP fixation system. Besides, we also found that the stress distribution on each point in the fracture block is obviously different. The D-point bears the minimum stress in both models. In the ALP fixation model, the C-point bears the greatest stress compared with the other points. However, in the PLP fixation model, the A-point bears the greatest stress and is far greater than that of the ALP fixation model on the same point（Fig 2）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEquivalent displacement\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of two fracture models\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe equivalent displacement changes of the two fixation systems increase gradually with the increase of the axial force, which can be well reflected in the displacement change of A-B-C-D points. We also found that the equivalent displacement of those 4 points on the ALP fixation method is larger than that of the PLP fixation system while there was no significant difference in the equivalent strain of each point compared with the two models (Fig 3). What\u0026apos;s more, the displacement changes at point A B C is more significant, while the displacement change at point D is the least obvious. (Table 2). When the axial force increases to 1000N, the maximum equivalent displacements of the ALP fixation system and the PLP fixation system are 0.66 and 0.78 mm respectively which are much lower than 2 mm, indicates that these two internal fixation methods can be regarded as stable fixation methods in clinical application.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe posterolateral tibial plateau fracture is a rare type of fracture [12] and it is not fully explained in Schatzker or AO classification systems [13,14]. Although the 3-\u0026nbsp;dimensional images are widely used, more orthopedic surgeons pay attention to fixation method of posterolateral tibial plateau fracture which are often caused by combining valgus and axial compressive forces when the knee joint is flexed, subsequently leading to the development of a fracture line. The fracture line is commonly found on the posterior surface of the bone\u0026rsquo;s coronal plane and is associated with complex multiple fractures with displaced fragments. This calls for surgical approaches that rebuild anatomical reduction and prevent secondary complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFinite element (FE) analysis, examines the geometric properties and predicts the influence of specific factors in a given fixation [15-16], because it can focus on one factor at a time. As a result, FE analysis was used in this study to approximate 2 dissimilar fixation systems for fixing the posterolateral tibial plateau fracture. In this study, we used the raft theory for the ALP and PLP which produces a stable tibial plateau after ORIF. It has been demonstrated that amidst the apex of fibular head and lateral wall of plateau, there is enough space to allow the horizontal arm of the plate to pass through as well as the two parallel screws to insert into the posterolateral tibial fracture fragment.\u003c/p\u003e\n\u003cp\u003eFor the two-fixation system, stress distributions in both cases on tibial plateau, could not be examined by other mechanical methods. The results of the current study showed that the maximum displacement was less than 2 mm after using the 2 fixation methods under vertical pressure of 1000N. This was considered clinically relevant positive outcomes after the reduction of tibial plateau fracture [17]. In present study, we calculate the stress distribution on models through comparable von Mises stress (EVMS). The 2 fixation methods had majority of the stress forces located on the junction of the posterolateral tibial fracture block and the tibial shaft. In ALP fixation system, the concentration region of stress appears at point C, while in PLP fixation system the concentration region of stress appears at point A. They are all in the boundary area of the fracture block, farthest from the inner fixed body, and subjected to the maximum compressive deformation force manifesting that these two regions influenced the load transmitted from the articular surface [18]. The motion characteristics of the two models differed, also the distribution of the EVMS inner of the fracture model is different, but both increase with the increase of the axial load. When the axial force applied to 1000N, the maximum equivalent stress of the ALP fixation system is 48.31 MPa, and the maximum equivalent stress of the PLP fixation system is 29.82 MPa, which indicates that the stability of the PLP fixation system is better than that of the ALP fixation system. This may be due to the fact that the T-plate provides a larger cross-sectional area on the upper surface of the tibial plateau than the L-shaped plate so the PLP fixation system provided high stability than ALP fixation system which can help in the early mobilizing step of weight bearing [19-20]. When the stress force was compared to maximum resistance of the simulated materials resulting in the maximum von Mises stress of 48.31MPa, which was lesser than the maximum resistance of 795MPa (titanium alloy) [21]. There was no evidence mechanical screw damage, plate damage or bending.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn present study, under the same axial force, the relative displacement of the A B C D point on the ALP fixation system is larger than that on the PLP fixation system, but there is no significant difference in equivalent strain at each point. This may be related to the difference between the two fixation methods. Compared with the ALP fixation system with two parallel screws, the PLP fixation system with three parallel screws provides a larger cross-sectional area that have a larger contact area between the screws and the fracture block, and are less prone to deformation [22]. The point A B C on the fracture model are located on the surface of the tibial plateau, and the point D is located below the tibial plateau. When the axial force is applied, the surface of the tibial plateau is subjected to the maximum stress, resulting in the most significant change in the displacement of the A B C point while the stress at point D is the smallest due to displacement is the least obvious.\u003c/p\u003e\n\u003cp\u003eAlthough the PLP fixation system is widely used in clinical practice due to its good mechanical stability, but this approach may result in delayed fracture healing due to vascular nerve injury due to large incisions [23]. Therefore, the anterolateral plate (ALP) fixation system can greatly reduce the operation time and reduce the risk of vascular nerve injury probably is a suitable method for patients who has the requirement of early weight bearing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe limitations included; stimulated cortical and cancellous bone materials were not exactly similar to the actual bone conditions. We were not able to simulate soft tissues, menisci and cartilage to surround the bones. The models were focused on stationary loading rather than dynamic loading because it requires highly skilled computer resources. This study only focused on axial loads. However, axial load is very vital because it is the cause of most fixation errors.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn summary, the posterolateral plate (PLP) fixation system can provided a better biomechanical stability than the anterolateral plate (ALP) fixation system in treatment of posterolateral tibia fracture though it may bring greater deformation. However, when it is necessary to consider the factors of the surgery itself, the orthopedic surgeon can choose a reasonable surgical method according to his own preferences and patient needs, as well as surgical complications.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFE: Finite Element; CT: Computed Tomography; EVMS: equivalent Von Mises Stress; APD: anteroposterior diameter; ALP: anterolateral plate; PLP: posterolateral plate\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Dr. Sheng-di Ding for providing linguistic assistance during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. SdD, WW and Dr. ZfZ established fracture model, and Dr. HbP , HjK, SfH analyzed and interpreted the patient data regarding the biomechanical test. Dr.WW and Dr. SdD ,StX were a major contributor in writing the manuscript. Dr. HbP and WW contributed equally to this work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Zhejiang Province Public Welfare Technology Application Research Project (CN), China (Grant No. LGF20H060009).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were performed in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of The First Hospital of Huzhou (approval number: 2019035). The ethics committee of the The First Hospital of Huzhou waived the need for informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details \u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Department of Orthopedics, The First Hospital of Huzhou, First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Huzhou, Zhejiang Province, 313000. China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e Huzhou Central Hospital, Huzhou Central Hospital of Zhejiang University, NO. 1558 Sanhuanbei Road, Huzhou, Zhejiang Province, 313000, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUrruela AM, Davidovitch R, Karia R, Khurana S, Egol KA. Results following operative treatment of tibial plateau fractures. J Knee Surg. 2013; 26:161-5. \u003c/li\u003e\n\u003cli\u003eQi-fang He, Hui Sun, et al. Tibial plateau fractures in elderly people: an institutional retrospective study. Journal of Orthopaedic Surgery and Research. 2018; 13:276.\u003c/li\u003e\n\u003cli\u003eBerber R, Lewis CP, Copas D, Forward DP, Moran CG. Postero-medial approach for complex tibial plateau injuries with a postero-medial or postero-lateral shear fragment. Injury. 2014; 45:757\u0026ndash;65. \u003c/li\u003e\n\u003cli\u003eLiu C D , Hu S J , Chang S M ,et al.Treatment of posterolateral tibial plateau fractures: a narrative review and therapeutic strategy[J].International Journal of Surgery, 2025, 111(1):12.\u003c/li\u003e\n\u003cli\u003eCarrera I, Gelber PE, Chary G, Gonzalez-Ballester MA, Monllau JC, Noailly J. Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. Int Orthop. 2016;40(10):2163\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eHu S J, Chang S M, Zhang Y Q, et al. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique[J]. Injury, 2015, 47(2):502-507.\u003c/li\u003e\n\u003cli\u003eMassey P A , Scalisi W , Duval C ,et al.Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating[J].JBJS Open Access, 2025, 10(1).\u003c/li\u003e\n\u003cli\u003eJordan M C , Zimmermann C , Gho S A , et al. Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures[J]. BMC Musculoskeletal Disorders, 2016, 17(1):287.\u003c/li\u003e\n\u003cli\u003eLuo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma. 2010; 24:683\u0026ndash;92. \u003c/li\u003e\n\u003cli\u003eLuo CA, Hua SY, Lin SC, Chen CM, Tseng CS. Stress and stability comparison between different systems for high tibial osteotomies. BMC Musculoskelet Disord. 2013; 14:110. \u003c/li\u003e\n\u003cli\u003eChen F, Huang X, Ya Y, et al. Finite element analysis of intramedullary nailing and double locking plate for treating extra-articular proximal tibial fractures[J]. Journal of Orthopaedic Surgery and Research, 2018, 13(1):12.\u003c/li\u003e\n\u003cli\u003eElsoe R, Larsen P, Nielsen NP, Swenne J, Rasmussen S, Ostgaard SE. Population-based epidemiology of tibial plateau fractures. Orthopedics. 2015;38(9): 780\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eTer Meulen DP, Janssen SJ, Hageman MG, Ring DC. Quantitative three- dimensional computed tomography analysis of glenoid fracture patterns according to the AO/OTA classification. J Shoulder Elb Surg. 2016;25(2):269\u0026ndash;75. \u003c/li\u003e\n\u003cli\u003eZhang, W. et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. The Knee. 2012; 19, 94\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eChen P, Lu H, Shen H, Wang W, Ni B, Chen J. Newly designed anterolateral and posterolateral locking anatomic plates for lateral tibial plateau fractures: a finite element study. J Orthop Surg Res. 2017;12(1):35. \u003c/li\u003e\n\u003cli\u003eKawabata Y, Matsuo K, Nezu Y, Kamiishi T, Inaba Y, Saito T. The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method. [J]. J Orthop Sci. 2017;22(5). \u003c/li\u003e\n\u003cli\u003eHaller JM, O\u0026apos;Toole R, Graves M, Barei D, Gardner M, Kubiak E, Nascone J, Nork S, Presson AP, Higgins TF. How much articular displacement can be detected using fluoroscopy for tibial plateau fractures? Injury. 2015; 46:2243\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eSassoon A A, Torchia M E, Cross W W, et al. Fibular Shaft Allograft Support of Posterior Joint Depression in Tibial Plateau Fractures[J]. Journal of Orthopaedic Trauma, 2014, 28(7): e169-e175.\u003c/li\u003e\n\u003cli\u003ePrat-Fabregat S, Camacho-Carrasco P. Treatment strategy for tibial plateau fractures: an update. EFORT Open Rev. 2016;1(5):225\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003ePatil S, Mahon A, Green S, McMurtry I, Port A. A biomechanical study comparing a raft of 3.5 mm cortical screws with 6.5 mm cancellous screws in depressed tibial plateau fractures. Knee. 2006; 13:231\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCarrera I, Gelber PE, Chary G, Gonzalez-Ballester MA, Monllau JC, Noailly J. Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration. Int Orthop. 2016;40(10):2163\u0026ndash;69. Epub 2016 Jan 16. \u003c/li\u003e\n\u003cli\u003eWeimann A, Heinkele T, Herbort M, et al. Minimally invasive reconstruction of lateral tibial plateau fractures using the jail technique: A biomechanical study[J]. BMC Musculoskeletal Disorders, 2013, 14(1):120.\u003c/li\u003e\n\u003cli\u003eWang Y, Luo C, Zhu Y, Zhai Q, Zhan Y, Qiu W, Xu Y. Updated three-column 39. concept in surgical treatment for tibial plateau fractures -a prospective cohort study of 287 patients. Injury. 2016;47(7):1488\u0026ndash;96. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"75%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 100px;\"\u003e\n \u003cp\u003eTable 1. Parameters of the FE models\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eNodes/elements of\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003ePLP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003ePlate\u0026amp; Screws\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e4371/13635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e3326/9516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eFragment\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e2165/7719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003e2434/8665\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eTibia shaft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e13188/53973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 33px;\"\u003e\n \u003cp\u003e23990/100983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Displacement changes of A B C D at each point on two fracture models.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"670\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003eD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eMax displacement (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003ePLP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003ePLP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003ePLP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003eALP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003ePLP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e250N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0688157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0509008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0462476\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0324038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0422082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0362376\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0324058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.0253227\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e500N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.137627\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.101802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.0924952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.064795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0844168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0724763\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0648116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.0506452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e750N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.206437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.152696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.138743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0971874\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.126626\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.108715\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.0972174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.0759676\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e1000N\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.275239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.203586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.18499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.129581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.168835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.144954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.129623\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.10129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tibial plateau Posterolateral fracture, Internal fixation, Finite element","lastPublishedDoi":"10.21203/rs.3.rs-7976233/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7976233/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eThe management of posterolateral tibial plateau fractures is mainly done by stable fixation which facilitates early mobility. Anterolateral locking plate (ALP) fixation and posterolateral locking plate (PLP) fixation are two commonly used fixation methods in clinical. This investigation’s aim was to examine the posterolateral tibial plateau biomechanical properties via arithmetical modeling and to quantify their effects on the fracture reconstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Two different 3D posterolateral tibial plateau fracture finite element models with the ALP and PLP fixation were created. The daily life axial compressive load on a typical adult knee was simulated using diversified axial forces (250N 500N 750N and 1000N). The comparable maps of displacement, stress and relative displacement were analyzed and quantified along the fracture lines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe comparable Von Mises Stress (EVMS) stresses and comparable displacement changes in the fixations were elevated and associated with axial force. However, under the same axial force, the EVMS of the PLP fixation system is smaller than that of the ALP fixation system. The concentration region of stress in two fixation systems is also different, which appears at point C in ALP fixation system and point A in PLP fixation system respectively. Under the same axial force, the displacement changes of the A-B-C-D point on ALP fixation system is larger than that on PLP fixation system, but there is no significant difference in equivalent strain at each point.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe computed results of stress of the fracture models show that the posterolateral locking plate (PLP) fixation system can provided a better biomechanical stability than the anterolateral locking plate (ALP) fixation system in treatment of posterolateral tibia fracture although their internal stress distribution was differed. However, if the equivalent displacement is also taken into account, the ALP and PLP fixation system had similar ability to resistant deformation.\u003c/p\u003e","manuscriptTitle":"A Comparative Biomechanical Analysis of Two Dissimilar Fixation Constructs for Posterolateral Tibial Plateau Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-24 13:57:26","doi":"10.21203/rs.3.rs-7976233/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T09:10:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-28T17:12:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-27T18:17:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T15:55:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T10:32:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154970052153233575902259610404901170010","date":"2025-11-19T05:20:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-17T23:28:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27621867492037938307375348180608497210","date":"2025-11-17T14:39:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"231109954914039020520003867310806733626","date":"2025-11-15T15:16:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74904711339213519313060743582414020227","date":"2025-11-14T16:18:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151862965360654995381853512955824863297","date":"2025-11-14T01:50:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270160484096479057919123440811023493491","date":"2025-11-13T16:17:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"201886232503822605036628752127916095530","date":"2025-11-13T07:55:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"140559348511816078173473505089189990292","date":"2025-11-12T15:01:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-12T14:28:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-09T09:45:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-04T09:56:58+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-04T09:52:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-10-29T06:21:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be9fb359-7aba-4db9-9e73-2cc46bca2da7","owner":[],"postedDate":"November 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2025-12-01T09:23:19+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-24 13:57:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7976233","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7976233","identity":"rs-7976233","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}