Background: Distal humerus fractures require stable fixation to restore elbow function, yet conventional plates often exhibit geometric mismatch with bone morphology, potentially com-promising biomechanical performance. Our finite element analysis (FEA) compared a novel anatomical plate, designed to conform to native humeral geometry, with a conventional plate for treating type B1 distal humerus fractures. Also, influence of meshing strategies on the out-comes was evaluated. Both adaptive and uniform approaches were considered.

Methods: A CT-based three-dimensional humerus model with heterogeneous bone properties was reconstructed from a 37-year-old female. An anatomically contoured plate was compared with a conventional locking plate. Adaptive and uniform meshing were applied separately to each model, and each construct was subsequently tested under 100 N tensile and compressive loads.

Results: The anatomic plate showed higher stiffness (up to 13%), broader contact pressure (23–28 MPa vs. conventional: 12–18 MPa) and larger sticking contact, whereas the convention-al plate produced higher shear stresses (p=0.113). Uniform meshing generated significantly greater interfragmentary motion than adaptive meshing (p=0.008) but caused unrealistically high screw stresses (up to 1526 MPa). Adaptive meshing predicted higher bone stresses, while uniform meshing concentrated stresses in screws. Despite meshing affecting absolute stress and strain magnitudes, comparative differences between plate designs remained consistent.

Conclusions: The anatomically contoured plate offers superior biomechanical stability over conventional designs for distal humerus fractures, as evidenced by reduced displacement and maintained fragment positioning conducive to healing. An adaptive meshing strategy appears to be more suitable for FEA of complex fixation components, as it yields more reliable stress distributions without altering primary comparative conclusions. Further experimental valida-tion is warranted before clinical application.

Level of evidence: V