Abstract:Objective: To evaluate the biomechanical effects of using locking plate osteosynthesis to treat hyperextension tibial plateau fractures. Methods: The hyperextension tibial plateau fracture model was constructed using the standardized artificial biomimetic tibia, and six groups of plate fixation schemas (1. Anterolateral, 2. Anteromedial, 3. Anterolateral + Anteromedial, 4. Anteromedial + Posteromedial, 5. Anterolateral + Posteromedial, and 6. Tri-plate Schema) were assembled for each model. Nine models were subjected to longitudinal loads of 250 N, 500 N, 1000 N, and 1500 N applied to the superior surface of the tibial plateau. The comprehensive displacement for each fixation schema was calculated using a three-dimensional camera system. Nine models were subjected to a uniform rotation of the proximal bone segment at a constant angular velocity of 0.5°/s. The torque required to achieve 10° of internal rotation and 10° of external rotation was recorded for each fixation schema. A repeated-measures analysis of variance was employed to assess the effects of fixation modality, compression (rotation), and their interaction on internal fixation outcomes. Pairwise comparisons were performed via paired t-tests, with multiple comparison adjustments implemented using the Bonferroni correction. Additionally, the paired standardized effect size (Cohen’s d) and its 95% confidence interval were calculated. Results: The axial load tests revealed that the greater the applied pressure, the larger the overall displacement. When the axial load was 1,500 N, the comprehensive displacement values of the groups of fixation schemas were as follows: Anterolateral (5.16±2.39 mm) > Anteromedial (4.04±1.40 mm) > Anterolateral + Anteromedial (2.56±0.57 mm) > Anteromedial + Posteromedial (1.75±0.71 mm) > Anterolateral + Posteromedial (0.70±0.27 mm) > Tri-plate Schema (0.34±0.10 mm). The horizontal rotation tests revealed that the average torque for a ±10° rotation was as follows: Anterolateral (9.87±2.07 N·m) < Anteromedial (10.61±1.91 N·m) < Anteromedial + Posteromedial (24.72±4.75 N·m) < Anterolateral + Anteromedial (27.61±3.06 N·m) < Anterolateral + Posteromedial (32.81±6.62 N·m) < Tri-plate Schema (43.95±8.23 N·m). At a load of 1500 N, within the dual-plate fixation schemas, the comprehensive displacement values of Groups 3 and 4 were significantly higher than that of Group 5 (P < 0.05). For the average torque, within the dual-plate fixation schemas, no significant differences in torque were detected between Group 3 and Group 4, or between Group 3 and Group 5 (P > 0.05); by contrast, the torque value of Group 5 was significantly higher than that of Group 4 (P < 0.05). Conclusion: For hyperextension tibial plateau fractures with intact articular surfaces, the fixation efficacy of locking plates increases with the number of plates used. Under the model and loading conditionsof this study, the dual-plate schema combining anterolateral and posteromedial plates exhibited smaller displacement and numerically higher torsional resistance, indicating a potential advantage in fixation performance. However, this does not provide sufficient evidence to conclude that its overall mechanical properties or clinical efficacy are significantly superior to those of other dual-plate schemas.