Abstract
The impact of the local mechanical environment in the fracture gap on the bone healing process has been extensively investigated. Whilst it is widely accepted that mechanical stimulation is integral to callus formation and secondary bone healing, treatment strategies that aim to harness that potential are rare. In fact, the current clinical practice with an initially partial or non-weight-bearing approach appears to contradict the findings from animal experiments that early mechanical stimulation is critical. Therefore, we posed the question as to whether optimizing the mechanical environment over the course of healing can deliver a clinically significant reduction in fracture healing time. In reviewing the evidence from pre-clinical studies that investigate the influence of mechanics on bone healing, we formulate a hypothesis for the stimulation protocol which has the potential to shorten healing time. The protocol involves confining stimulation predominantly to the proliferative phase of healing and including adequate rest periods between applications of stimulation.
Highlights
We predominantly examine the influence of the mechanical environment on secondary healing in the diaphysis of long bones, as this represents the condition most often studied in pre-clinical models
Reflecting on the last 70 years of research in the field of bone repair, we pose a provocative question of whether healing time can be significantly reduced by the modulation of the mechanical environment in the fracture gap
Decades of in vivo research led to the development of the biological internal fixation [53] that significantly improved fracture biology
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The biomechanics of fracture healing has been scientifically investigated for at least the past 70 years [1]. Multiple studies have investigated the influence of local mechanical conditions on the progression of fracture healing; clinical translation of this understanding is limited. We asked whether there is still potential for biomechanics to make substantial improvements to the clinical treatment of fractures. We posed the question whether there is potential to significantly shorten the healing time through optimization of the mechanical environment over the course of healing?
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