Voxel based finite element analysis for tibia plateau strength assessment.

Accurate assessment of bone strength is critical for predicting fracture risk, particularly in load bearing regions such as proximal tibia. In this study, we developed and validated a voxel-based finite element (FE) modelling approach to estimate the mechanical strength of the proximal tibia in the context of Schatzker Type II tibial plateau fractures. CT scans of twenty-two cadaveric tibiae were used to construct subject-specific FE models incorporating density-based heterogeneous material properties. Both linear and non-linear FE simulations were performed and compared with experimental failure loads obtained from mechanical tests. The linear FE model, using the Pistoia criterion to estimate bone strength, showed weak correlation (R2 ranging from 0.18 to 0.53) with experimental results and tended to overestimate the failure load with a bias of 1.59 kN. In contrast, the non-linear FE model, incorporating elastic-plastic material behaviour with damage softening, yielded improved predictions with a mean bias of -0.12 kN. Also, the non-linear model demonstrated strong agreement with experimental observations, accurately capturing strain localization that closely matched the actual fracture path. This study demonstrates that voxel-based mesh approach offers the ability to quantify tibial bone strength. It utilizes a highly automated and time-efficient workflow, potentially enhancing fracture risk prediction in clinical practice.