Abstract: This paper systematically reviewed the development history, mechanisms of action, and frontier advances of bone wax, a core hemostatic material in orthopedics. This paper first analyzed conventional hemostatic strategies in surgery and their application limitations in complex wounds, emphasizing the special requirements of orthopedic hemostasis for the synergistic adaptation between material biocompatibility and bone healing processes. Ideal hemostatic materials for bone surfaces must strike a balance between “effective intraoperative hemostasis” and “avoiding long-term adverse reactions”. They should ensure effective hemostasis before physiological hemostasis stabilizes at the skeletal site, and simultaneously, their residence time in vivo should be coordinated with the key early stages of bone healing. On this basis, this paper outlined the evolutionary trajectory from traditional non-absorbable bone wax to absorbable bone wax and analyzed the composition characteristics, degradation performance, and application advantages and limitations of various products in different clinical scenarios. Furthermore, this paper explored the in vivo metabolic pathways of core components including polyethylene glycol, poloxamer, polylactic acid, and calcium phosphate materials and investigated the mechanisms by which their degradation and absorption behaviors affect bone healing outcomes. Finally, this paper envisioned the development trend of bone surface hemostasis from passive “physical occlusion” of non-absorbable bone wax toward “biological synergy” of absorbable bone wax and pointed out that future research should focus on the integrated hemostasis-osteogenesis model, enhancement of antibacterial functions, personalized customization strategies, and construction of clinical validation systems, thereby facilitating the realization of true biological healing in orthopedic hemostatic repair.

Key words: hemostatic material, bone wax, physical occlusion, biological synergy