## 4 Discussion
\begin{table}
\begin{tabular}{c c c} \hline \hline
**Bone Plate Type** & **Maximum Bone Plate von Mises Stress (MPa)** & **Stiffness (N/mm)** \\ \hline ADT & 228.82 & 52.12 \\ MDT & 181.00 & 1576.58 \\ ADLT & 144.15 & 1219.51 \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Comparison between fixation with anterolateral (ATL), the medial distal tibia (MDT) and Asia Distal Lateral Tibial (ADLT) plate fixation. numbers of bone screws. Bone screws of the same diameter and length were employed to fix the fragmented bone in each bone plate model. Six bone screws were implanted at the bone plate proximal side. The difference with another bone plate, Synthes 3.5 mm ADT applied just six screws to fix the fragmented bone. Aplus ADLT and Synthes 3.5 mm MDT implanted eight bone screws at bone plate distal side. The difference between Aplus ADLT and Synthes 3.5 mm MDT include the implanted position and the geometrical configurations except for the number of screws. In addition, the opposite screw insertion technology have the potential advantage in the stresses on the bone plate and screws [25]. In this study, the Aplus ADLT bone plate system has minimum VMS stress in the plate and bone displacement Z-axis. The Aplus ADLT has these advantages included below; the lateral bone plate can avoid the soft tissue injury, triangular and anatomical plate design at the bone plate distal side. It has maximum rate in covering the bone surface. It is a locking plate design, although there may be issues such as fragment rotational instability, this situation could not be simulated in this study. The use of locking head screws, in addition to the ligamentotaxis effect of the surrounding tissue, may have overcome this issue. It is well established that locking screws have larger pullout mechanism than conventional thereby maintaining the bone-implant construct stability [26]. Most stress around the screw hole of the ADT were higher than 100 MPa while the stress in many regions of the ADLT and MDT was under than 50 MPa, indicating the ADT might have more possibility of plate breakage during rehabilitation period. It was noted that von Mises stress was concentrated at the bend of the ADT and the MDT, which could be explained by leverage of load transmitted from the distal screws. Interestingly, the location of stress concentration for the ADLT was at the articular of the implant, meaning the implant design could provide anti-bending effect. The screw hole placement in the articular part of the ADLT features a triangle fixation configuration for fragment capture and two struct screws to resist the external force. These may contribute to high resistance to plate bending during loading. Consequently, we suggested that the newly designed implant, ADLT could be an alternative option for the treatment of the tibial pilot fractures. The Aplus ADLT could offer the similar stiffness with MDT plate and better than ALT plate. Therefore, the Aplus ADLT could be one of a suitable design in tibia distal fracture fixation. Several limitations were observed in this study. The plate-bone constructs were examined under one loading and boundary condition based on previous publications [6; 14; 27]. In this present study, only one dimension was analyzed, the different tibia dimension was included to evaluate in further study. As we know, this simulated situation is certainly not representative of all physiological environment. Further development of new model to simulate more physiological conditions is necessary for future researches such as the evaluation of the risk of implant failure and the mechanics between implant-bone interfaces and the dynamic loading condition. The dynamic loading enhances the growth factors reaction [28]. The ADLT is a new implant expected to provide adequate stability for fracture fixation as the medial distal tibial plate (MDT) do. The lowest biomechanical requirement for a bone plate is to assure the initial stability after the fracture fixation.