Bioaugmented osteosynthesis: precise monitoring and intervention of the bone healing microenvironment

Abstract Bone healing is integral to orthopedic research, focusing on the restoration of bone function through a complex interplay of inflammatory responses, soft callus formation, hard callus development, and the final remodeling phase. While the natural progression of bone healing is a finely tuned process, it can be disrupted by inflammatory dysregulation, ranging from chronic inflammation to acute inflammatory anomalies, and by the depletion of essential repair substances under both chronic and acute conditions. Current strategies to enhance bone healing employ a multifaceted approach, including biochemical modulation of the local microenvironment through essential nutrient supplementation (e.g., calcium and vitamin D), biomechanical optimization via improved internal fixation stability, and advanced regenerative techniques incorporating bioactive factors, stem cell therapies, and functional biomaterials. Despite these efforts, challenges persist in the precise characterization of the local microenvironment and the precise control of in vivo bioactive molecule delivery. This review comprehensively summarizes the current research progress in bone healing, providing significant reference for understanding the mechanisms of bone healing and for guiding further research. It is expected to lay the theoretical foundation for the development of more effective therapeutic strategies for bone healing.