Current concepts in fracture healing: temporal dynamization and applications for additive manufacturing

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Regenerative Medicine

Background:

• Current rigid metallic implants for fracture repair offer adequate outcomes but do not utilize advances in mechanotransduction.
• Optimizing fracture healing requires a deeper understanding of how mechanical forces influence bone regeneration.

Purpose of the Study:

• To review the efficacy and clinical potential of surgical techniques and implants that introduce interfragmentary motion during bone healing.
• To explore how dynamic mechanical stimuli can enhance fracture repair outcomes.

Main Methods:

• Systematic literature search of PubMed and Google Scholar for studies on dynamic locking plates, dynamized techniques, and reverse dynamization.
• Inclusion of research on additively manufactured (AM) implants designed for dynamic mechanical behavior.

Main Results:

• Forty articles confirmed that staged surgeries and dynamic implants accelerate fracture healing.
• Temporal dynamization (static fixation followed by micromotion) improves callus volume and healing rates.
• Reverse dynamization (early micromotion, later arrest) shows promise for critical defect injuries.
• Additive manufacturing advancements enable high-resolution implants for dynamized and reverse dynamized treatments.

Conclusions:

• Fracture healing optimization is not a one-size-fits-all solution.
• Systematically altering construct stiffness during healing phases, achievable with AM implants, significantly enhances fracture treatment.