Recent advances of chitosan-based composite hydrogel materials in application of bone tissue engineering.

Bone defects, stemming from trauma, tumors, infections, and congenital conditions, pose significant challenges in orthopedics. Although the body possesses innate mechanisms for bone self-repairing, factors such as aging, disease, and injury can impair these processes, jeopardizing skeletal integrity. Addressing substantial bone defects remains a global orthopedic concern, with variables like gender, lifestyle and preexisting conditions influencing fracture risk and complication rates. Traditional repair methods, mainly bone transplantation including autografts, allografts and xenografts, have shown effectiveness but also present limitations. Autologous bone grafts, highly valued for their osteogenic properties, require additional surgeries with extended hospitalization, and carry risks associated with the donor site. The development of advanced biomaterials offers promising new avenues for bone repair. An ideal material should exhibit a combination of biocompatibility, biodegradability, bone conduction, porosity, strength, and the ability to stimulate bone formation. Chitosan (CS), derived from chitin, stands out due to its biocompatibility, biodegradability, low immunogenicity, non-toxicity, and a wide range of biological activities, including antioxidant, anti-tumor, anti-inflammatory, antimicrobial, and immunomodulatory properties. Notably, CS has shown the properties to promote bone regeneration, increase bone density, and accelerate fracture healing. This review provides a comprehensive examination of CS-based hydrogels for bone repair aiming to inspire researchers by presenting new ideas for innovative CS-based solutions, thereby advancing their potential applications in the field of bone repair.