Mechanobiological Integration and Regenerative Strategies in Contemporary Orthopedic Trauma

摘要

Fracture healing in contemporary orthopedic trauma care is increasingly understood as a mechanobiological process governed by the interaction between mechanical stability, inflammatory regulation, vascular supply, and cellular differentiation. This review synthesizes current evidence on the biological phases of fracture repair, the regulatory role of the mechanical microenvironment, and the integration of regenerative strategies such as biomaterials, tissue engineering, and mesenchymal stem cell–based interventions. Foundational molecular models describe fracture healing as a coordinated sequence of inflammatory, reparative, and remodeling events, while mechanobiological research demonstrates that interfragmentary strain and fixation strategy actively modulate tissue differentiation pathways. Clinical frameworks, including the diamond concept, further emphasize that successful regeneration depends on the coordinated presence of osteogenic cells, scaffolds, growth factors, adequate vascularization, and mechanical stability. Complications such as non-union and fracture-related infection illustrate the consequences of disrupted mechanobiological balance. The temporal evolution of the literature reflects a transition from descriptive biological models toward integrated translational approaches that combine biomechanics and regenerative medicine. Collectively, the findings support a systems-based paradigm in which surgical decision-making, biological preservation, and regenerative enhancement function as interconnected determinants of outcome. This integrated perspective is particularly relevant for high-burden trauma systems, where optimizing fundamental mechanobiological principles may substantially improve fracture healing and functional recovery.