**Case of FITO**

Fito is a 4-year old German Sheppard of around 40kg. Fito was hit by a car and suffered femur fracture. X-rays showed a multiple diaphysal fracture with big bone splinters. The bone fracture was repaired with a standard titanium plate and 12 screws of M3.5. During the intervention, the surgeon noticed that the plate had to be modified by hand to fit the damaged zone. Surgeon was modelling the plate with a pair of surgical pliers, and verifying visually that the plate was fitting properly. However, as mentioned before, this approach has two principal drawbacks: the surgical intervention is prolonged and the material of the plate suffers plastic deformation, which reduces significantly its fatigue behaviour and even causing precocious plate fracture.

Fig. 21. From left to right: lateral and frontal view of the fracture; X-rays immediately after the intervention and X-rays after the plate fracture was detected (Courtesy of CIMA and FAUNA).

The later drawback appeared after only 3 days, Fito started to limp severely, presenting an angular deformation in the femoral zone. The plate suffered a fracture and completely lost its functionality (as shown on the last image of Figure 21).

Fig. 22. Customized CAD design (above) fracture fixation plate build on EBM (below).

was also observed that a primary consolidation (the best possible) took place thanks to the

Fito is a 4-year old German Sheppard of around 40kg. Fito was hit by a car and suffered femur fracture. X-rays showed a multiple diaphysal fracture with big bone splinters. The bone fracture was repaired with a standard titanium plate and 12 screws of M3.5. During the intervention, the surgeon noticed that the plate had to be modified by hand to fit the damaged zone. Surgeon was modelling the plate with a pair of surgical pliers, and verifying visually that the plate was fitting properly. However, as mentioned before, this approach has two principal drawbacks: the surgical intervention is prolonged and the material of the plate suffers plastic deformation, which reduces significantly its fatigue behaviour and even

Fig. 21. From left to right: lateral and frontal view of the fracture; X-rays immediately after

The later drawback appeared after only 3 days, Fito started to limp severely, presenting an angular deformation in the femoral zone. The plate suffered a fracture and completely lost

Fig. 22. Customized CAD design (above) fracture fixation plate build on EBM (below).

the intervention and X-rays after the plate fracture was detected

its functionality (as shown on the last image of Figure 21).

proper load distribution.

causing precocious plate fracture.

(Courtesy of CIMA and FAUNA).

**Case of FITO** 

In order to avoid this problem a specific customized plate was designed and made in Ti64 ELI (Grade 23) ASTM F136 (ASTM, 2010) on EBM (Figure 22).

Fig. 23. Left: images showing size and weight of the customized plate. Right: post-surgery Xrays image of the plate (Courtesy of CIMA and FAUNA).

All case studies exposed above have shown that the use of customized implants makes the recovery of patients faster with fewer problems related to posterior revision surgeries, such as screw loosening, plate damage and fracture. In addition, it is important to highlight that, in some of these cases, plates were successfully removed after the bone was recovered, detecting that the bone had completely recovered its functionality.

Regarding Additive Manufacturing, these case studies show that EBM technology is a powerful tool for the manufacturing of customized implants due to:


Accordingly, the EBM process has been validated as one of the main options in case of customized implants: not expecting to replace existing production processes but to be an excellent alternative with certain advantages.
