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Finite element analyses were conducted to compare four conventional techniques: single plate, intramedullary nail, combined plate and nail, and double plate. These were then evaluated with the addition of three porous Ti\u20106Al\u20104V scaffold designs (Weaire\u2013Phelan, Diamond, and Voronoi) with 70% porosity. Models were subjected to peak physiological loading from gait, simulating a 106\u2009kg patient. Performance was assessed based on implant stress and the volume fraction of the fracture callus experiencing osteogenic strains (0.005%\u20132.5%). Results showed that conventional single\u2010implant methods were mechanically insufficient; the single plate failed at 20% of the physiological load and the nail at 90%. These methods also produced suboptimal osteogenic environments, with an osteogenic volume fraction &lt;\u200916%. In contrast, combined conventional methods (plate and nail, double plate) withstood 100% of the load with significantly lower stresses and promoted highly osteogenic environments, with an osteogenic volume fraction &gt;\u200995%. The integration of 3D\u2010printed scaffolds transformed the single\u2010implant constructs, enabling them to withstand 100% physiological load and increasing their osteogenic volume fraction to over 90%. Scaffolds also substantially reduced stress on the primary implants in all configurations. The plate and nail fixation augmented with a scaffold emerged as the most robust strategy, reducing conventional implant stresses to approximately 140\u2009MPa while maintaining an exceptional osteogenic volume fraction &gt;\u200999%. These findings highlight the quantitative potential of 3D\u2010printed scaffolds to improve treatment outcomes for large bone defects.<\/jats:p>","DOI":"10.1002\/jbmb.70010","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T03:55:15Z","timestamp":1765511715000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Finite Element Analysis of Conventional Fixation and\n                    <scp>3D<\/scp>\n                    \u2010Printed Scaffold Integration for Treating Large Osseous\u00a0Femoral Defects"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5694-5336","authenticated-orcid":false,"given":"Panagiotis","family":"Ntakos","sequence":"first","affiliation":[{"name":"Laboratory of Machine Design National Technical University of Athens  Zografou Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Kalligeros","sequence":"additional","affiliation":[{"name":"Laboratory of Machine Design National Technical University of Athens  Zografou Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Chouzouris","sequence":"additional","affiliation":[{"name":"Laboratory of Machine Design National Technical University of Athens  Zografou Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Gakos","sequence":"additional","affiliation":[{"name":"Laboratory of Machine Design National Technical University of Athens  Zografou Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios F.","family":"Foukas","sequence":"additional","affiliation":[{"name":"Third Department of Orthopaedic Surgery \u201cKAT\u201d General Hospital of Athens  Kifissia Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Armakolas","sequence":"additional","affiliation":[{"name":"Department of Experimental Physiology Medical School, National and Kapodistrian University of Athens  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0733-6565","authenticated-orcid":false,"given":"Olga D.","family":"Savvidou","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedic Surgery National and Kapodistrian University of Athens, Faculty of Medicine, Attikon University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panayiotis J.","family":"Papagelopoulos","sequence":"additional","affiliation":[{"name":"First Department of Orthopaedic Surgery National and Kapodistrian University of Athens, Faculty of Medicine, Attikon University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Spitas","sequence":"additional","affiliation":[{"name":"Laboratory of Machine Design National Technical University of Athens  Zografou Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2022.11.006"},{"issue":"5","key":"e_1_2_12_3_1","first-page":"441","article-title":"Spontaneous Healing of Large Femoral Cortical Bone Defects: Does Genetic Predisposition Play a Role?","volume":"69","author":"Hinsche A. 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