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. 2025 Jun 6;15(1):19987.
doi: 10.1038/s41598-025-04792-w.

Advantages of digital twin technology in orthopedic trauma Surgery - Exploring different clinical use cases

Annchristin Andres  1 , Michael Roland  2 , Kerstin Wickert  2 , Stefan Diebels  2 , Johannes Stöckl  3 , Stefan Herrmann  3 , Frank Reinauer  4 , Ralf Leibinger  4 , Atanas Pavlov  5 , Lutz Schuppener  5 , Daniel Schäfer  6 , Tina Histing  6 , Benedikt J Braun  6
Affiliations

Advantages of digital twin technology in orthopedic trauma Surgery - Exploring different clinical use cases

Annchristin Andres et al. Sci Rep. .

Abstract

Digital twin technology offers significant benefits for addressing fracture non-unions in orthopedic trauma surgery, particularly in cases requiring revision surgery. In this study, we developed a clinically applicable digital twin workflow that integrates patient-specific imaging, motion capture, musculoskeletal modeling, and finite element simulation. We applied this workflow to five real patient cases involving different anatomical sites and treatment strategies, including implant modification, augmentative fixation, and corrective osteotomy. Each case was virtually reconstructed to evaluate mechanical conditions before and after revision surgery. The results demonstrated that digital twins can predict improvements in implant stress distribution and fracture strain states, offering valuable insights for optimizing surgical decisions. This work highlights the feasibility of digital twins and their clinical value in supporting individualized revision strategies, laying the foundation for their broader use in trauma care. .

Keywords: Digital twin; Fracture healing; Individualized Biomechanical simulation; Non-unions; Patient-specific model generation; Surgical treatment.; Virtual reconstruction.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics Statement: Ethical approval for this study was indeed obtained, and all participants provided written informed consent. All study procedures involving human participants were conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the University of Tuebingen (protocol codes 317 and 318/2022BO2). Patients were recruited from the outpatient trauma surgery clinic, and all participants provided written informed consent prior to inclusion in the study.

Figures

Fig. 1
Fig. 1
Comparison of the strain state-based healing window in the fracture and the von Mises stress distribution for a diameter change of an intramedullary nail.
Fig. 2
Fig. 2
Comparison of the fracture’s strain state-based healing window and the treatment’s von Mises stress distribution with and without an adaptive humerus plate.
Fig. 3
Fig. 3
Comparison of the strain state-based healing window of the fracture and the von Mises stress distribution of the treatment with and without an adaptive femur plate.
Fig. 4
Fig. 4
Comparison of the strain state-based healing window of the fracture and the von Mises stress distribution of the treatment with and without an additional screw.
Fig. 5
Fig. 5
Preoperative case, A: 0-degree ulnar deviation, B: 40-degree ulnar deviation, C: contact during the 40-degree ulnar deviation with fade-out rigid body part for better visualization.
Fig. 6
Fig. 6
Postoperative case, A: 0-degree ulnar deviation, B: 40-degree ulnar deviation.
Fig. 7
Fig. 7
The consortium introduces different levels of digital twin maturity.
Fig. 8
Fig. 8
Visualization of the workflow starting with the patient monitoring, then the inverse dynamic calculation of the joint forces, the generation of the 3D models, and the FE simulation with the applied boundary conditions.
See this image and copyright information in PMC

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