Electrical stimulation as an emerging strategy in bone repair: Mechanisms, applications, and advances.

The treatment of critical-sized bone defects remains a substantial clinical challenge in orthopaedics. Electrical stimulation (ES), which mimics the endogenous bioelectric and piezoelectric properties of bone tissue, has emerged as a promising non-invasive modality to facilitate bone regeneration. This review elucidates the multifaceted mechanisms through which ES coordinately enhances osteogenesis, angiogenesis, and inflammation resolution, primarily via the regulation of key signalling pathways and modulation of the immune microenvironment at molecular and cellular levels. We also highlight recent advances in the integration of ES with electroactive biomaterials, enabling more targeted and efficacious therapeutic outcomes. Robust clinical evidence supports the ability of ES to significantly accelerate fracture healing, underscoring its translational relevance and potential for broad clinical adoption. By synthesizing these developments, this review aims to inform and inspire the design of next-generation bone regeneration strategies. The translational potential of this article: ES offers a non-invasive or minimally invasive therapeutic modality that can significantly accelerate fracture healing and bone regeneration. This review synthesizes current mechanistic understanding and clinical evidence, highlighting ES as a potential alternative to secondary revision surgery for nonunion fractures. By integrating ES with electroactive biomaterials and emerging self-powered implantable devices, future strategies can be translated into personalized, intelligent bone repair systems, reducing patient morbidity and healthcare costs.