In silico biomechanical evaluation of personalized A-shaped titanium plates for mandibular condylar base fractures

The anatomical complexity of the mandibular condylar base renders open reduction and internal fixation challenging for fractures in this region. Although the double-straight-plate fixation remains the most widely adopted clinical strategy, its implementation is frequently hindered by technical limitations inherent to conventional operative routes. The biomechanical adequacy of single-geometric-plate fixation has not been conclusively established and warrants rigorous experimental validation. This study developed personalized A-shaped plates with 5-, 6-, and 7-hole configurations, geometrically optimized to adjust the curvature of the anterior arm to accommodate the anatomical contour of the sigmoid notch. Subsequently, the biomechanical efficacy of these personalized plates in stabilizing condylar base fractures was systematically evaluated. Finally, a multi-dimensional quantitative comparison was conducted to assess biomechanical differences between the proposed single-geometric-plate fixation and conventional fixation protocols. The 7-hole-A-shaped-plate configuration demonstrated biomechanical performance equivalent to the double-straight-plate configuration across all parameters. The 6- and 5-hole-A-shaped-plate configuration achieved comparable global stability but exhibited significantly elevated stress concentration in either fixation hardware or adjacent cortical bone. The in silico study furnishes robust biomechanical evidence to support individualized selection of A-shaped geometric fixation for condylar base fractures.