## 1 Introduction  
Currently, metallic fixation medical implants (i.e., plate and screws) are the standard procedure to treat fractured bones for a variety of traumatic and pathological bone disorders [1]. Clinical outcomes showed successful follow-up evaluations [2]. The ideal bone plate scenario is to stabilize the fractured bone fragments with minimal or no interference to the bone remodeling process. However, clinicians and researchers agree that the metallic biomaterials used to build fixation implants for bone treatment have an effect on the bone healing efficiency [3; 4; 5]. This is mainly due to the stiffness mismatch between the implant and bone; for example, Ti-6 Al-4V elastic modulus is -120 GPa with a density of 4.43 g/cm\({}^{3}\), whilst cortical bone ranges from 15 to 25 GPa [3]. [PERSON]'s law states that the biomechanical forces subjected to bone will stimulate the remodeling process [4]. Hence, the plate's stiffness strongly influences this process [4; 5]. Subsequently, in the bone-plate fracture region, the loads will be distributed unevenly, mainly absorbed by the plate and screws. The bone will be stress shielded from the required stimuli due to the excessive stiffness of the metallic implant, thus leading to decreased mineralization, implant loosening and bone resorption and over the long-term, significant bone density reduction and potential for bone fracture [4; 5]. Stress shielding is one of the primary causes of failures in fracture fixation that requires expensive further clinical intervention [6]. Removal of metalwork increases the risk of bone refracture or nerve damage. However, if the fixation is kept in situ, which is not infrequent with adverse reactions such as soft tissue irritation, further stress shielding, growth disturbance and protentional carcinogenic, toxic and allergic reactions can occur [7; 8]. This demonstrates how crucial the development of new metallic fixation implants involving advancements in fixation architecture and materials is to prevent and minimize these issues. Addressing the elimination or minimization of the stress shielding phenomenon in treating bone fractures is a major research topic. Mainly, these studies are divided into two key research problems focusing on either the fixations materials or the design. Several studies have investigated the incorporation of biomaterials into the implant that have a similar stiffness to bone [9; 10; 11; 12]. For example, biodegradable biomaterials have become a major trend in the development of fracture fixations due to their mechanical properties (e.g., Young's modulus of polyglycolic acid is 5-7 GPa) and its ability to degrade while matching the bone healing period and eventually eliminate the risk of stress shielding [9]. However, biodegradable biomaterials show significant limitations when it comes to withstanding physiological loads over a long period and matching the specific biomechanical and degradation performance of bone during healing (i.e., maintaining suitable biomechanics) [10]. Hence, biodegradable biomaterials are more popular in the tissue engineering field due to their more suitable performance in low load-bearing applications (e.g., trabecular bone scaffolds) [11; 12]. An ideal design for a medical fixation implant is tailored to optimize its topology, geometry and shape to create a lightweight structure with more flexibility and able to resist physiological loads without any failure. Plate failure is commonly determined by either plastic deformation, crack or plate fracture. It has been demonstrated by several authors that by redesigning the bone plate, stress shielding can be reduced [13; 14]. In addition, medical implant design research has shown that patient-specific bone plates provide superior mechanical and biomechanical behavior over the standard computer aided bone plate designs [15]. This assists the preoperative planning preventing, minimizing complications [16].