• Minimally invasive combinations (medial plate plus tension screws) achieved biomechanical stability comparable to traditional double plating in finite element analysis.
• Group B (medial plate plus two posteromedial tension screws) exhibited the lowest fracture fragment stress (9.0392 MPa), making it ideal for elderly patients to prevent osteoporosis-related collapse.
• Group C (medial plate plus two lateral tension screws) showed the smallest implant displacement (4.388 mm), offering excellent stability for young patients while avoiding posteromedial approach risks.
• The study provides evidence-based support for selecting minimally invasive fixation strategies to balance mechanical stability and soft tissue preservation in Schatzker IV fractures.