A Concert between Biology and Biomechanics: The Influence of the Mechanical Environment on Bone Healing

Abstract

In order to achieve consistent and predictable fracture healing, a broad spectrum of growth factors are required to interact with one another in a highly organized response. Critically important, the mechanical environment around the fracture site will significantly influence the way bone heals, or if it heals at all. The role of the various biological factors, the timing, and spatial relationship of their introduction, and how the mechanical environment orchestrates this activity, are all crucial aspects to consider. This review will synthesize decades of work and the acquired knowledge that has been used to develop new treatments and technologies for the regeneration and healing of bone. Moreover, it will discuss the current state of the art in experimental and clinical studies concerning the application of these mechano-biological principles to enhance bone healing, by controlling the mechanical environment under which bone regeneration takes place. This includes everything from the basic principles of fracture healing, to the influence of mechanical forces on bone regeneration, and how this knowledge has influenced current clinical practice. Finally, it will examine the efforts now being made for the integration of this research together with the findings of complementary studies in biology, tissue engineering, and regenerative medicine. By bringing together these diverse disciplines in a cohesive manner, the potential exists to enhance fracture healing and ultimately improve clinical outcomes.

Mechanobiology of the corneal epithelium

“…Many biomaterials incorporate specific biological components such as growth factors and cytokines to replicate conditions cells experience in vivo ( Chen and Liu, 2016 ) or to promote matrix deposition ( Ahearne et al, 2014 ). These biological components can influence how cells behave and the matrix proteins they deposit which in turn affect the mechanical properties of the environment ( Glatt et al, 2016 ). As cells change the mechanical properties of their environment, the new environment can affect how the cells behave thus creating a dynamic reciprocity between cells and environment ( Ahearne, 2014 ).…”

Research in Fracture Healing and Its Clinical Applications in the Veterinary Practice

“…A mechanical stimulation has also recently been investigated using a massage-like compression to enhance muscular healing with positive results [24]. The idea of a change in fixation stability, even though investigated for some time now in a research setting has so far not reached the clinic [25][26][27][28]. More often the change in the fixation regime is dictated by an unsatisfactory healing progression [29].…”

The effect of housing environment on bone healing in a critical radius defect in New Zealand White rabbits

“…Physical activity is known to influence the proliferation and differentiation of mesenchymal progenitor cells into chondrocytes and osteoblasts in the callus [23]. Apart from stimulating healing, the risk for osteopenia with subsequent osteoporosis is reduced with physical activity [24].…”