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Comparative Study
. 2025 Jul 26;26(1):715.
doi: 10.1186/s12891-025-08996-z.

Biomechanical effects of six internal fixation methods for distal femoral AO/OTA 33C1 fractures: finite element analysis

Jianxiong Zhang  1 , Jiadi Le  1 , Zhenghao Wu  1 , Long Chen  2
Affiliations
Comparative Study

Biomechanical effects of six internal fixation methods for distal femoral AO/OTA 33C1 fractures: finite element analysis

Jianxiong Zhang et al. BMC Musculoskelet Disord. .

Abstract

Purpose: Using finite element analysis, to compare the stress and deformation of six different internal fixation methods for distal femoral fractures to obtain the optimal internal fixation method.

Methods: Create six groups based on different placement methods and fixation methods: 5-hole lateral plate (SP); 5-hole lateral plate + two medial screws (SP + D); 5-hole lateral plate + one trans-plate screw (SP + O); 5-hole lateral plate + one cross screw (SP + C); 5-hole lateral plate + elastic nail (SP + S); 5-hole lateral plate + medial T-shaped plate (SP + T). Observe the displacement distribution and maximum displacement at the fracture site, and stress distribution on the medial fracture fragment and internal fixation.

Results: After applying the load, mechanical indicators for internal fixation and bone blocks were obtained for all six models by finite element method. The model with a lateral single plate showed max internal fixation stress of 221.75 MPa, which was greater than other models. On the other hand, the model with a 5-hole lateral plate and medial T-shaped plate showed the smallest internal fixation stress (125.74 MPa) and the smallest total femoral deformation (0.99416 mm).

Conclusion: The combination of a 5-hole lateral plate and a medial T-shaped plate demonstrated significant biomechanical advantage compared to the other five groups. Although the 5-hole lateral plate model is slightly inferior compared to the 5-hole lateral plate and medial T-shaped plate, it remains an effective and safe fixation solution for AO/OTA 33C1 type fractures.

Keywords: Distal femur fracture; Finite element analysis; Locking Plate.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committee of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University (approval No. 2024–K–200–01). Informed consent has been obtained from the participant. Our research adheres to the principles of the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
T-shaped fracture model and 3D CT images of T-shaped fracture
Fig. 2
Fig. 2
Six internal fixation models: a Lateral Single Plate group (SP). b Lateral Plate + Elastic Nail group (SP + S). c Lateral Plate + Cross Screw group (SP + C). d Lateral Plate + Double Screw group (SP + D). e Lateral Plate + Oblique Screw group (SP + O). f Lateral Plate + Medial T-shaped Plate group (SP + T)
Fig. 3
Fig. 3
A case of distal femoral fracture treated with a combination of lateral plate and elastic nail internal fixation
Fig. 4
Fig. 4
The distal end of the femur is fixed with relative displacement constraints. A 730 N of iliac reaction force (directed 20° downward relative to the long axis of the femur), directly facing the center of the femoral head. B 300 N of abductor force (directed 20° upward relative to the long axis of the femur). C 188 N of iliopsoas force (directed 45° upward relative to the long axis of the femur). D 192 N of vastus lateralis force (parallel to the long axis of the femur)
Fig. 5
Fig. 5
Contours of the total deformation of the entire length of the femur
Fig. 6
Fig. 6
Contours of maximum displacement at the fracture surface
Fig. 7
Fig. 7
Contours of maximum von Mises stress on fracture block
Fig. 8
Fig. 8
Contours of maximum von Mises stress on internal fixation
See this image and copyright information in PMC

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