Exploring Schatzker IV Tibial Plateau Fracture: Finite Element Analysis Study of Five Internal Fixation Methods

Abstract Purpose This research aims to evaluate the stress and stability of Schatzker IV-C subtype tibial plateau fractures through finite element simulation, comparing various internal fixation techniques. Methods A 3D finite element model was created for a Schatzker IV C tibial plateau fracture, evaluating five internal fixation methods through computer simulations. The methods included: Medial Plate (Model 1), Medial Plate with Two Posterior Tension Screws (Model 2), Medial Plate with Two Lateral Tension Screws (Model 3), Dual Plates on Anterior and Posterior Medial Sides (Model 4), and Dual Plates on Medial and Lateral Sides (Model 5). To simulate the biomechanics of unilateral knee joint axial compression during normal adult gait, a substantial axial force of 1200N was applied, with 60% selectively distributed on the medial plateau. Comprehensive analyses focused on equivalent von Mises stress, displacement, and the Equivalent Graph illustrating stress-displacement characteristics for each fixation modality. Results The MTS model exhibits the highest peak stress of 139.45 MPa, coupled with a maximum displacement of 4.4945 mm, outperforming all other models. In contrast, the MPLT model has a lower peak stress and displacement of 96.08 MPa and 4.391 mm, respectively. This model stands out for having the smallest displacement among all models and significantly reduced maximum stress compared to the initial three groups. As for the three DPMs, their peak stresses are documented at 95.144, 91.46, and 92.58 MPa, accompanied by peak displacements of 4.3982, 4.4326, and 4.4382 mm, respectively. Conclusion The research findings suggest that Model 4 is the optimal treatment choice due to its minimal displacement, significantly reduced maximum stress compared to other models, and advantages such as minimal trauma for postoperative recovery. Double steel plate models exhibit low stress levels but lack outstanding displacement reduction, and their significant surgical trauma makes them a secondary choice. This study provides insights into the biomechanical performance of different internal fixation methods for Schatzker IV C tibial plateau fractures.