BIONATURE

Fracture healing represents one of the most fundamental challenges in veterinary orthopaedic practice, encompassing the management of a diverse range of species, body sizes, fracture configurations, and clinical contexts. Achieving optimal fracture repair requires not only appropriate mechanical fixation but also the creation of a favourable biological environment conducive to bone regeneration. This review critically evaluates the evolving landscape of strategies employed to enhance fracture healing in veterinary patients, drawing on evidence from peer-reviewed literature published between 1996 and 2026. The mechanistic underpinnings of bone fracture healing are reviewed, followed by a systematic discussion of established and emerging interventions. These include conventional and advanced internal fixation techniques—notably locking compression plates and minimally invasive plate osteosynthesis (MIPO)—as well as biological adjuncts such as platelet-rich plasma (PRP), bone morphogenetic proteins (BMPs), and mesenchymal stem cell (MSC) therapy. Physical modalities including photobiomodulation therapy (PBMT) and extracorporeal shockwave therapy (ESWT) are evaluated in the context of their proposed mechanisms and clinical evidence in veterinary species. The role of three-dimensional (3D) printing and bone tissue engineering scaffolds in addressing critical-sized bone defects is also examined. The management of delayed union and non-union fractures, which represent the most clinically demanding complication of fracture treatment, is discussed in detail. Species-specific considerations for small animals, equines, and large ruminants are addressed throughout. The review identifies significant gaps in comparative evidence across veterinary species and calls for more rigorously designed clinical trials. A multimodal, biologically informed approach appears to offer the greatest potential for optimising fracture healing outcomes in diverse veterinary patients. The rapid pace of development in regenerative medicine, biomaterials science, and additive manufacturing means that some of the most recent advances may not yet have been fully evaluated at the time of this review, and practitioners are encouraged to monitor emerging literature critically and with appropriate methodological scrutiny.