Development of a novel surgical plate for Hoffa fractures

Purpose This study proposes a novel plate design as a surgical solution for Hoffa fracture through an anterolateral approach and to performs comparative nonlinear finite element analyses among existing solutions in the clinical literature. Methods Four fixation constructs for Letenneur type 1 Hoffa fractures were numerically modeled and mechanically compared: (1) two 4.5 mm cannulated screws in the A-P direction; (2) a one-third locking plate on the posterolateral distal femur with two 4.5 mm cannulated screws in the P-A direction; (3) a horizontally applied one-third locking tubular plate with two 4.5 mm cannulated screws in the A-P direction; and (4) a proposed novel Y-shaped locking plate with three locking holes, one compression hole, and two 4.5 mm cannulated screws in the A-P direction. After applying a 4 mm displacement, all models were calibrated using pre-existing experimental results and subjected to a biological load. Results With a biological load of 523.63 N, Model 2 remained biomechanically superior. Model 1 showed poor biomechanical performance, indicating possible fixation failure. Models 3 and 4 presented satisfactory results that encourage their use in anterolateral approaches. The proposed plate reduced displacements, stresses, and plasticized volume compared to Model 3, in addition to presenting greater clinical versatility. The proposed plate was not experimentally validated; the results are based on the modeling methodology applied to Models 1 through 3. Conclusion Model 1 and Model 2 were confirmed as the least and most biomechanically stable methods, respectively. The proposed plate (Model 4) demonstrated superior mechanical performance compared to the conventional horizontal locking plate (Model 3). These findings indicate that the new design provides enhanced construct rigidity while preserving the surgical benefits of an anterolateral approach. However, we acknowledge that the posterolateral plate configuration remains biomechanically superior.