Finite element analysis, biomechanics, and clinical advantages of percutaneous medial column screw reinforced locking plate in the treatment of complex distal femoral fractures

Jiahao Chen; Jialu Chen; Renjie Lu; Yi Liu; Junwu Huang; Chi Zhang

doi:10.1302/2046-3758.151.BJR-2025-0128.R2

Finite element analysis, biomechanics, and clinical advantages of percutaneous medial column screw reinforced locking plate in the treatment of complex distal femoral fractures

Bone Joint Res. 2026 Jan 22;15(1):73-87. doi: 10.1302/2046-3758.151.BJR-2025-0128.R2.

Authors

Jiahao Chen^{1

2}, Jialu Chen¹, Renjie Lu¹, Yi Liu³, Junwu Huang⁴, Chi Zhang^{1

2}

Affiliations

¹ Department of Orthopedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
³ The International Peace Maternity and Child Health Hospital, Shanghai, China.
⁴ Orthopaedics Department, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China.

PMID: 41564905
PMCID: PMC12823196
DOI: 10.1302/2046-3758.151.BJR-2025-0128.R2

Abstract

Aims: The main treatment method for distal femoral fractures is open reduction and internal fixation with a lateral locking plate. However, the literature indicates that the failure rate for this method is high, the healing is slow, and the prognosis is poor. Therefore, this study aimed to solve the problems of high failure rate and poor rehabilitation.

Methods: Data from 140 patients with AO/OTA type 33 A/33 C fractures (September 2014 to December 2023) were retrospectively analyzed. After excluding 20 cases (loss to follow-up, Gustilo III fractures, polytrauma), 120 patients were categorized into three groups: locking compression plate (LCP) alone, LCP + percutaneous medial column screws (PMCS), and LCP + auxiliary inner locking plate (ALP). An A3 fracture model of the distal femur with medial bone defect was established to explore the maximum stress and maximum displacement. Biomechanical simulations were carried out under axial, torsional, and bending loads. Clinical outcomes, finite element analysis, and biomechanical tests were compared.

Results: The LCP + PMCS technique showed better therapeutic effects compared with the other two groups. There were significant differences in fracture healing time (p < 0.001), range of knee joint motion (p < 0.001), and incidence of complications (p = 0.007). The finite element analysis results showed that the maximum stress and displacement of LCP + PMCS made it the optimal method among the three groups. Biomechanical tests confirmed that LCP + PMCS had higher yield load and stiffness.

Conclusion: LCP combined with PMCS offers enhanced biomechanical stability, reduced complications, and minimally invasive advantages, making it a promising strategy for distal femoral fractures, particularly in elderly and osteoporotic patients.