Finite element analysis in tibial plateau fractures: a systematic review of literature.

Abstract

The objective of this study was to systematically summarize and critically evaluate the available evidence on the biomechanical performance of fixation plates in the treatment of tibial plateau fractures. This systematic review was conducted in accordance with PRISMA guidelines. A comprehensive search (from inception to September 2025) across multiple databases identified studies that used finite element (FE) models to assess orthopedic hardware in tibial plateau fractures. Inclusion criteria required the use of FE analysis with specific fixation methods. Data extraction and risk of bias assessment were performed independently by two reviewers using standardized tools. Thirty-one studies were included. Most reconstructed fracture models from patient-derived CT data or synthetic tibias. While all distinguished cortical from trabecular bone, few incorporated bone mineral density variations or applied physiological dynamic loading. Considerable heterogeneity was observed in material properties, boundary conditions, and meshing strategies, limiting reproducibility and cross-study comparability. Only a minority of models used subject-specific data or validated results against experimental or clinical benchmarks. All studies were classified as high risk of bias according to ROBFEAD criteria. Current FE models for tibial plateau fractures are limited by a universally high risk of bias, predominantly relying on simplified geometries, omitting dynamic loading, and critically lacking mechanical validation. The marked heterogeneity among studies poses a major challenge to evidence synthesis and translation into surgical decision-making. Future research must prioritize patient-specific models, dynamic loading conditions, and standardized reporting to enhance clinical relevance.