Andrés Orlando Gualdrón Cantor

Spinal fractures are frequently associated with prolonged functional impairment, delayed ambulation, and reduced independence, particularly when neurological involvement or prolonged immobilization is present. Conventional rehabilitation remains the cornerstone of recovery; however, its capacity to deliver early, intensive, and repetitive gait training may be limited in patients with pain, biomechanical instability, or reduced motor control. In this context, robotic lower-limb exoskeletons have emerged as a promising rehabilitative technology capable of supporting upright mobility and structured gait practice. This review analyzes current evidence on robotic exoskeleton-assisted rehabilitation with specific emphasis on its potential role in post-fracture spinal recovery and the acceleration of functional reintegration. A structured narrative review methodology was employed, integrating findings from neurological rehabilitation, spinal cord injury studies, orthopedic rehabilitation research, and biomechanical analyses. The results indicate that exoskeleton-assisted gait training is associated with improved walking initiation, increased training intensity, reduced assistance requirements, and acceptable safety profiles when applied under appropriate clinical protocols. Although direct evidence in spinal fracture populations remains limited, the biomechanical rationale and indirect clinical findings support the conceptual applicability of exoskeleton-assisted rehabilitation in this group.

Delayed bone healing remains a significant challenge in traumatology, particularly in complex fractures and biologically compromised environments where conventional fixation alone may be insufficient to achieve timely consolidation. In recent decades, bioactive biomaterials have emerged as relevant adjuncts in orthopedic trauma, offering not only structural support but also biological modulation of the fracture microenvironment. This review aims to synthesize current evidence on the clinical applications of bioactive biomaterials in delayed bone healing, focusing on their biological mechanisms, material design principles, and prognostic implications. A structured narrative review was conducted using peer-reviewed literature addressing bioactive glasses, calcium orthophosphate ceramics and cements, composite scaffolds, and injectable biomaterials. The results indicate that bioactive glass and composite scaffold strategies are frequently associated with favorable healing profiles, while calcium phosphate systems remain widely utilized due to their established clinical reliability and versatility. Injectable biomaterials demonstrate procedural advantages but show greater variability in outcomes, reflecting formulation and indication heterogeneity. Across all material classes, mechanical stability and infection control emerge as the most influential prognostic factors, underscoring that biomaterials function optimally as biological enhancers rather than substitutes for sound trauma principles. Overall, bioactive biomaterials represent a valuable component of contemporary fracture management when selected according to defect characteristics, biological conditions, and clinical context. This review provides an educational framework to support evidence-based decision-making in delayed bone healing, with relevance to trauma care settings in Latin America and beyond.