ORIGINAL RESEARCH article
Front. Sports Act. Living
Sec. Injury Prevention and Rehabilitation
This article is part of the Research TopicInsights into biomechanics, injury prevention, and AI to promote racket sportsView all articles
Comparative Finite Element Analysis of Fixation Strategies for Sports-Related Tibial Tuberosity Avulsion Fractures in Adolescents: Biomechanical Evidence for Optimized Clinical Decision-Making
Provisionally accepted
- General Division, Pediatric Orthopedic Hospital, Honghui Hospital, Xi’an Jiaotong University, Honghui Hospital, Xi'an, China
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Objective: This finite element study aimed to biomechanically compare screw fixation versus K-wire fixation for adolescent tibial tubercle avulsion fractures (TTAF), investigating the differential biomechanical outcomes and physeal insult associated with each fixation method. Methods: A finite element model of an adolescent tibia with a Modified Ogden type III fracture was developed. Three fixation types—(A) screws, (B) two non-crossing K-wires, and (C) four crossing K-wires—were tested both as standalone constructs and in their tension band-augmented counterparts. Simulations applied a 1654 N tensile load to simulate patellar tendon force, with outcomes assessed by fragment displacement, bone and epiphyseal von Mise stress. Results: Screw fixation (Type C3) demonstrated the highest stability, with fragment displacement of 1.97 mm and the lowest bone stress (295.79 MPa). K-wire constructs showed greater displacement and stress. The addition of a third fixator provided minimal stability improvement compared to two. Tension bands increased stability in K-wire models but raised bone stress to approximately 1100 MPa and increased physeal stress. Conclusion: Biomechanical analysis of TTAF reveals that screw fixation provides enhanced stability and reduced bone stress compared to K-wire fixation. Furthermore, the stability achieved with dual screws is comparable to that of triple screws, implying that adding more implants offers a limited advantage in fracture fixation stability. Considering the greatest physeal insult, particularly in skeletally immature individuals with retained growth potential, tension band wiring should be used sparingly. Based on these results, screw fixation is recommended as the optimal approach for adolescent TTAF.
Keywords: Tibial tuberosity avulsion fracture, Finite Element Analysis, screwfixation, Kirschner wire, Biomechanics, Adolescent
Received: 22 Oct 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 Wang, Zhang, Tuo, Liu, Meng, Tong, Yang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoming Wang, albin5489@163.com
Bing Wang, wangbingheli@163.com
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