Postmortem and Antemortem Forensic Assessment of Pediatric Fracture Healing from Radiographs and Machine Learning Classification.

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Abstract

Conflict of interest statement: The authors declare no conflict of interest. 4. Bone Res. 2026 Apr 7;14(1):39. doi: 10.1038/s41413-026-00522-8. Bone adhesive with temporally-synchronized degradation for enhanced osteointegration. Gu JT(#)(1)(2), Li ZT(#)(1), Wang YZ(#)(1), Hao DX(1), Dang GP(1), Cao XQ(3), Tay FR(4), Chen JH(1), Aparicio C(5)(6), Jiao K(7)(8), Niu LN(9). Author information: (1)National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China. (2)National Translational Science Center for Molecular Medicine, Department of Cell Biology, State Key Laboratory of Cancer Biology, The Fourth Military Medical University, Xi'an, Shaanxi, China. (3)The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China. (4)Dental College of Georgia, Augusta University, Augusta, GA, USA. (5)Catalan Institute for Research and Advanced Studies (ICREA), Barcelona, Spain. conrado.aparicio@upc.edu. (6)BOBI- Bioinspired Oral Biomaterials and Interfaces, Department of Materials Science and Engineering, EEBE, Technical University of Catalonia (UPC)-Barcelona Tech, Barcelona, Spain. conrado.aparicio@upc.edu. (7)National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China. kjiao1@163.com. (8)Department of Stomatology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China. kjiao1@163.com. (9)National Clinical Research Center for Oral Diseases & State Key Laboratory of Military Stomatology & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China. niulina831013@126.com. (#)Contributed equally Bone adhesives have emerged as promising alternatives for complex fracture fixation. However, discrepancies between material degradation rates and the physiological timeline of bone healing remain a critical limitation. Here, a polyurethane-based adhesive (TNC) was developed, synthesized from trimeric hexamethylene diisocyanate, nano-hydroxyapatite, and type I collagen. The TNC demonstrates strong initial adhesion to both wet and blood-contaminated bone surfaces and exhibits excellent biocompatibility. A distinguishing feature of TNC is its capacity to synchronize degradation with the stages of bone healing. During degradation, TNC forms a mineralized surface layer that releases calcium ions. The calcium ions activate cathepsin K, an enzyme integral to bone remodeling. This calcium-mediated mechanism accelerates TNC degradation by 1.9-fold during the remodeling phase compared to the initial phase. In a rat skull fracture model, TNC supported effective fracture stabilization and achieved favorable bone regeneration at 8 weeks after implantation. These findings demonstrate that TNC combines early mechanical stability with phase-specific degradability to facilitate bone regeneration in a temporally-controlled manner. The present work provides a framework for the development of bio-responsive bone adhesives that synchronize degradation behavior with healing phases for orthopedic applications. © 2026. The Author(s). DOI: 10.1038/s41413-026-00522-8 PMCID: PMC13057037