Finite element analysis of Bi-condylar Tibial Plateau fractures to assess the effect of coronal splits

•Almost 50% of complex tibial plateau fractures consist of the posteromedial fragment which has been disregarded in previous experimental studies assessing mechanical stability.•Detailed understanding about load sharings within implants would provide mechanical evidence for fixation strategy.•This study used FEA to evaluate the effects of coronal fracture lines on structural stability and stress distributions within the lateral plates and screws.•The coronal fracture line considerably effects the stress distributions within lateral locking implants along with destabilization of bone-implant constructs. Bi-condylar tibial plateau fractures are demanding to treat due to the complex geometry and the articular comminution. The presence of a coronal fracture line plays a crucial role in the fixation strategy. Disregarding this fracture line in previous biomechanical studies and established fracture classifications resulted in a lack of detailed knowledge regarding the influence of medial-posterior fragments on implant load sharings. This study aimed to evaluate the effects of coronal splits on stress distributions within the implants using the finite element analysis (FEA). FE models with (Fracture C) and without the coronal split (Fracture H) were developed and validated in order to assess stress distributions within the implant components. Comparing FE outcomes with biomechanical experiments indicated that both fracture models were well validated. FE evaluations demonstrated that the coronal split caused destabilization of the medial tibia, as well as a shift in the peak-stress areas from the middle part of the plate to the proximal section, and a 61% increase in the maximum stress of the kick-stand screw. Therefore, FE models based on clinically-relevant fracture morphologies can provide a reliable tool to assess implant failures as well as to compare different fracture fixation techniques.