## 5 Conclusions  
A multi-objective comparative analysis was carried out in order to differentiate between mechanical stability characteristics of three commonly used tibial plateau fracture (type V Schatzker classification system) fixation systems: classic L plate, Locking Plate System and Hybrid External Fixator.  
The L plate showed the lowest performance in terms of mechanical stability as shown previously in other similar studies ([PERSON] and [PERSON] [51]). The best performance was found in the case of the Locking Plate System. Hybrid External Fixator system provided a mechanical resistance only slightly lower than that of Locking Plate System plate. However, with the increase of the load, it was observed that the difference between the mechanical resistances of Locking Plate System plate and Hybrid External Fixator system becomes less significant.  
The present study developed an artificial neural network model to predict the implant deformation as a function of load with the purpose of establishing if a significant functional dependence exists between implant deformation and applied force. Another objective of the analysis was to determine if the implant type has a significant influence on the implant deformation over the whole range of the applied force. As it was observed that the difference between the mechanical resistance of Locking Plate System type becomes comparable with that of the Hybrid External Fixator, a question was raised if a clear-cut distinction between implant deformation for Locking Plate System and for Hybrid External Fixator at higher force values, in other words if choosing PLS over Hybrid External Fixator has a significant advantage from the mechanical resistance standpoint when high loads are expected.  
A machine learning algorithm--Support Vector Machine--was employed in order to analyse the implant deformation data and establish boundaries for data points depending on whether they belong to one or another implant type. It was found that the SVM classifier placed Locking Plate System data points increasingly closer to the Hybrid External Fixator region as the applied force increased. This is equivalent to say that no clear-cut distinction (statistically significant) could be identified between Locking Plate System and Hybrid External Fixator at high values of the applied force. However, at low and moderate values of the applied force, Locking Plate System performs better than Hybrid External Fixator.  
The conclusions of the study can be synthesized in a recommendation: in cases where significant load is expected to be exerted on the implant device--bone assembly, other factors such as the extent of surgical trauma should weigh more in the medical decision since in such cases Hybrid External Fixator system performs similarly from a bio-mechanical point of view. As the micromovement at the fracture site is a key factor in the fracture healing process, it is critical to control its value, which is determined by the implant device type and the applied force.  
Conceptualization, B.N., C.I.F. and T.T.T.; methodology, B.N. and B.M.D.; software, B.M.D.; formal analysis, B.M.D. and M.C.; investigation, B.N. and C.I.F.; resources, B.N., C.I.F. and T.T.; data curation, B.M.D.; writing--original draft preparation, B.M.D.; writing--review and editing, M.C.; visualization, B.N.; supervision, M.C. All authors have read and agreed to the published version of the manuscript.  
This research received no external funding.  
The authors declare no conflict of interest.