25dkou449 10.3205/25dkou449 urn:nbn:de:0183-25dkou4496 Meeting Abstract Sommerhalder Sommerhalder Lea L

CustomSurg AG, Zürich, Schweiz

author Comtesse Comtesse Simon S

ETH Zürich, Zürich, Schweiz CustomSurg AG, Zürich, Schweiz

author Zumbrunn Zumbrunn Thomas T

CustomSurg AG, Zürich, Schweiz

author Zamboni Zamboni Lara L

CustomSurg AG, Zürich, Schweiz

author von Keudell von Keudell Arvind A

Brigham and Women’s Hospital, Harvard Medical School, Boston, USA Bispebjerg Hospital, Kopenhagen, Dänemark CustomSurg AG, Zürich, Schweiz

author German Medical Science GMS Publishing House

Düsseldorf

610 20251031 engl This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). M0634 449 Deutsche Gesellschaft für Orthopädie und Unfallchirurgie Deutsche Gesellschaft für Orthopädie und Orthopädische Chirurgie Deutsche Gesellschaft für Unfallchirurgie Berufsverband für Orthopädie und Unfallchirurgie Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2025) Abstracts | Digitalisierung 1 Berlin 20251028 20251031 AB70-4383 TextObjectives and questions: Complex tibial plateau fractures pose significant challenges in orthopedic surgery due to their intricate nature and potential complications [1]. Plate and screw fixation is a common surgical approach, but the optimal positioning of plates and screws remains a topic of debate.Finite Element Modelling (FEM) provides a quantitative method for evaluating the biomechanical performance of various osteosynthesis constructs under physiological loading conditions [2].This study aims to improve conventional preoperative planning by using FEM as a measure for assessing and optimizing biomechanical performance. It is hypothesized that optimized osteosynthesis configurations provide greater stability than standard approaches.Material and methods: Schatzker IV fractures with lateral depression were induced in six left human lower extremity cadaveric specimens (Rimasys, Germany). They underwent a computed tomography (CT) scan, after which the proximal tibia fragments were segmented and realigned to achieve anatomic fracture reduction. All fracture fixations were planned with a medial variable angle locking plate (Pangea, Stryker, Switzerland). Initial implant configurations were based on standard surgical planning by a fellowship trained surgeon. Then, each case underwent an iterative process to optimize plate and screw positions by means of FEM. To evaluate the stability of the osteosynthesis constructs, initial and final configurations were biomechanically simulated using Abaqus (Simulia, Dassault Systèmes, France). Knee joint reaction forces were scaled according to patient weight and patient-specific Hounsfield-Unit-derived bone material properties were applied to the 3D model.Results: The mean maximal displacement magnitude for the initial surgeon configuration was 1.17 mm (SD = 0.43 mm) while in the optimized configuration, it was 0.66 mm (SD = 0.19 mm) which corresponds to a mean relative reduction of 39.25%. This represents a significant reduction in maximal displacement (p = 0.01) achieved with no significant change in number of screws used (MInitial = 11, SD = 1.27, MOptimized = 11, SD = 0.89, p = 0.50).Discussion and conclusions: Optimizing plate and screw positioning significantly reduced displacement compared to conventional planning, especially in initially unstable constructs.The improvement in stability was particularly pronounced in constructs where the initial configuration showed large displacements.Hence, patient-specific FEM provides valuable insights into how plate positioning affects fracture stability, which may guide orthopedic surgeons towards optimized plate placement strategies.Figure 1 0

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