Revisiting bone healing strategies: the potential of reverse dynamization in veterinary orthopedics

Reverse dynamization is an emerging orthopedic strategy that modulates fixation stiffness throughout fracture healing to better align the mechanical environment with the evolving biological requirements of tissue repair. In contrast to traditional dynamization, which typically begins with rigid fixation followed by progressive destabilization, reverse dynamization permits controlled early interfragmentary motion before increasing construct stiffness during later stages of healing. This review examines the biological and biomechanical foundations of reverse dynamization and evaluates its potential relevance for companion animal orthopedic surgery. Current preclinical evidence from rodent, ovine, and caprine models suggests that reverse dynamization can accelerate callus formation, improve tissue organization, enhance vascularization, and increase the mechanical competence of healing bone compared with static or conventionally dynamized fixation strategies. These findings support the concept that staged modulation of fixation stiffness may better reflect the changing mechanobiological requirements of fracture repair. Particular attention is given to veterinary-specific considerations, including quadrupedal locomotion, variable postoperative loading, reliance on secondary bone healing, and the potential applicability of adaptive fixation systems such as external fixators and dynamic implant constructs. However, the available evidence remains largely restricted to controlled experimental models and is limited by small sample sizes, sparse independent replication, and the absence of clinical studies in veterinary patients. Reverse dynamization should therefore be regarded as a promising mechanobiological concept rather than an established clinical strategy in veterinary orthopedics. Further veterinary-specific investigations are required to define optimal mechanical parameters, evaluate clinical feasibility, and determine whether the benefits observed in experimental models translate to routine fracture management in companion animals.