Tibial shaft fractures represent approximately 37% of all long bone fractures in adults. The management of these fractures is complex, and the risk of malunion, delayed union, and nonunion remains high, contributing to considerable patient disability, reduced quality of life, and significant treatment costs. Nonunion fractures are a persistent challenge in orthopaedic clinical practice. When a nonunion occurs, patients experience prolonged disability and higher rates of depression, opioid use, and narcotic dependency.

There is an unmet need for improved fracture management approaches that consistently create an optimal biomechanical environment for healing, reduce nonunion rates, shorten recovery time, and lessen patient and societal burden. Preclinical and clinical studies have repeatedly shown that bone fracture healing proceeds most efficiently when two biomechanical conditions are met: