Fracture fixation, then and now: When implants learn to heal

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Digital Health

Background:

• Conventional fracture fixation offers mechanical stability but is biologically passive.
• Limitations include nonunion, delayed healing, and implant complications, highlighting the need for a new paradigm.
• Advances in materials, biology, and digital tech challenge the fixation-centric model.

Purpose of the Study:

• To propose a reframing of fracture management.
• Shift focus from mechanical support to a dynamic host-implant interaction.
• Emphasize implants sensing, responding, and adapting to the biological environment.

Main Methods:

• Narrative and conceptual synthesis of current literature.
• Integration of evidence from materials science, biomechanics, bioengineering, immunology, and digital health.
• Identification of design principles and translational pathways for biologically centered fracture care.

Main Results:

• A framework for dynamic host-implant dialogue based on five principles: designed temporality, biological integration, mechanical modulation, therapeutic multifunctionality, and feedback intelligence.
• Ten technological pathways illustrate practical applications integrating mechanical, biological, and digital intelligence.
• Demonstration of interactive paradigms in fracture management.

Conclusions:

• Fracture care is shifting from "fixing bones" to "orchestrating healing."
• Implants are transitioning from static hardware to dynamic partners in treatment.
• This represents a philosophical shift towards a dynamic partnership between biology, technology, and clinical judgment.