AbstractTo obtain a very fast solution for finite element models used in surgical simulations, low‐order elements, such as the linear tetrahedron or the linear under‐integrated hexahedron, must be used. Automatic hexahedral mesh generation for complex geometries remains a challenging problem, and therefore tetrahedral or mixed meshes are often necessary. Unfortunately, the standard formulation of the linear tetrahedral element exhibits volumetric locking in case of almost incompressible materials. In this paper, we extend the average nodal pressure (ANP) tetrahedral element proposed by Bonet and Burton for a better handling of multiple material interfaces. The new formulation can handle multiple materials in a uniform way with better accuracy, while requiring only a small additional computation effort. We discuss some implementation issues and show how easy an existing Total Lagrangian Explicit Dynamics algorithm can be modified in order to support the new element formulation. The performance evaluation of the new element shows the clear improvement in reaction forces and displacements predictions compared with the ANP element in case of models consisting of multiple materials. Copyright © 2008 John Wiley & Sons, Ltd.