Purpose -The purpose of this paper is to study the use of the additive manufacturing (AM) method, electron beam melting (EBM), for manufacturing of customized hip stems. The aim is to investigate EBM's feasibility and commercial potential in comparison with conventional machining, and to map out advantages and drawbacks of using EBM in this application. One part of the study concerns the influence on the fatigue properties of the material, when using the raw surface directly from the EBM machine, in parts of the implant. Design/methodology/approach -The research is based on a case study of manufacturing a batch of seven individually adapted hip stems. The stems were manufactured both with conventional machining and with EBM technology and the methods were compared according to the costs of materials, time for file preparation and manufacturing. In order to enhance bone ingrowths in the medial part of the stem, the raw surface from EBM manufacturing is used in that area and initial fatigue studies were performed, to get indications on how this surface influences the fatigue properties. Findings -The cost reduction due to using EBM in this study was 35 per cent. Fatigue tests comparing milled test bars with raw surfaced bars indicate a reduction of the fatigue limit by using the coarse surface. Originality/value -The paper presents a detailed comparison of EBM and conventional machining, not seen in earlier research. The fatigue tests of raw EBM-surfaces are interesting since the raw surface has shown to enhance bone ingrowths and therefore is suitable to use in some medical applications.

This paper addresses the evaluation of clavicle fixation devices, by means of computational models. The aim was to develop a method for comparison of stress distribution in various fixation devices, to determine whether the use of multibody musculoskeletal input in such model is applicable and to report the approach. The focus was on realistic loading and the motivation for the work is that the treatment can be enhanced by a better understanding of the loading of the clavicle and fixation device. The method can be used to confirm the strength of customised plates, for optimisation of new plates and to complement experimental studies. A finite element (FE) mesh of the clavicle geometry was created from computed tomography data and imported into the FE solver where the model was subjected to muscle forces and other boundary conditions from a multibody musculoskeletal model performing a typical activity of daily life. A reconstruction plate and screws were also imported into the model. The combination models returned stresses and displacements of plausible magnitudes in all included parts and the result, upon further development and validation, may serve as a design guideline for improved clavicle fixation.

In the cases, when clavicle fractures are treated with a fixation plate, opinions are divided about the best position of the plate, type of plate and type of screw units. Results from biomechanical studies of clavicle fixation devices are contradictory, probably partly because of simplified and varying load cases used in different studies. The anatomy of the shoulder region is complex, which makes it difficult and expensive to perform realistic experimental tests; hence, reliable simulation is an important complement to experimental tests. In this study, a method for finite element simulations of stresses in the clavicle plate and bone is used, in which muscle and ligament force data are imported from a multibody musculoskeletal model. The stress distribution in two different commercial plates, superior and anterior plating position and fixation including using a lag screw in the fracture gap or not, was compared. Looking at the clavicle fixation from a mechanical point of view, the results indicate that it is a major benefit to use a lag screw to fixate the fracture. The anterior plating position resulted in lower stresses in the plate, and the anatomically shaped plate is more stress resistant and stable than a regular reconstruction plate.

There is a trend toward operative treatment for certain types of clavicle fractures and these are usually treated with plate osteosynthesis. The subcutaneous location of the clavicle makes the plate fit important, but the clavicle has a complex shape, which varies greatly between individuals and hence standard plates often have a poor fit. Using computed tomography (CT) based design, the plate contour and screw positioning can be optimized to the actual case. A method for patient-specific plating using design based on CT-data, additive manufacturing (AM), and postprocessing was initially evaluated through three case studies, and the plate fit on the reduced fracture was tested during surgery (then replaced by commercial plates). In all three cases, the plates had an adequate fit on the reduced fracture. The time span from CT scan of the fracture to final implant was two days. An approach to achieve functional design and screw-hole positioning was initiated. These initial trials of patient-specific clavicle plating using AM indicate the potential for a smoother plate with optimized screw positioning. Further, the approach facilitates the surgeon's work and operating time can be saved.

Bone plates for the fixation of complex fractures in proximity to joints often have to be reshaped to follow the bone contour. Good adhesion of the screws in areas where the bone is osteoporotic is also a challenge. One possible solution to these issues is to tailor-make plates by creating a digital three-dimensional model of the fracture from a computed tomography (CT) scan, digitally reducing the fracture, designing a plate, and finally manufacturing it directly from the digital model with solid free-form fabrication (SFF) technology. This study designs a custom plate for a distal tibia fracture, and investigates and refines the procedure from the CT scan to the final implant, with the aim of making it usable in trauma orthopaedics. The bone plate is manufactured using electron beam melting (EBM) technology. The challenges of bone plate design using digitalization and SFF are discussed. The virtual models created by the engineer while digitally reducing the fracture and modeling the plate are valuable for the physician while planning the surgery. A combination of surgery planning and digital plate design improves the surgeon's preparations and ensures correspondence between the plan and the designed implant. The proposed procedure, with the approximate required time in brackets, includes the separation of bone in the DICOM file (60 min), the reduction of fracture (5-30 min), revision (30 min), modelling of the plate (30-120 min), confirmation (30 min), manufacturing with SFF (10 h), post-processing (60 min), and finally cleaning and sterilization (90 min). The whole procedure requires about three working days.