In ageing societies, the need for innovative products and clinical procedures for fracture treatment is increasing due to more age-related fractures and comorbidities such as osteoporosis or postsurgery complications like infections. Innovations must reduce the total cost of care or clearly improve the quality of care at a justifiable cost and bring new solution to outstanding medical challenges. The industrial sectors for innovation are broad covering implants, imaging, pharmaceuticals, wound care or single-use surgery devices. These trends already led to a rising demand for innovation and investments e.g. by the European medical technology industry which increased their R&D spend 11% from 2012 to 2013.At the same time, research and innovation (R&I) within fracture management is facing various challenges in understanding clinical needs and effectiveness, reducing costs of innovation and time to market. Clinicians and companies often lack insight into the total costs of care, the effectiveness of treatment and the causes of adverse health outcome in hospitals. To overcome these challenges, clinical fracture registries can provide evidence in the clinical “real world” and reveal needs and potentials for innovation. Further, clinicians and hospitals are important actors in the innovation process helping to identify needs and to ensure user oriented products. Around 50% of new products are initiated by clinicians. Accordingly, companies in the NSR need direct access to hospitals and clinicians for collaboration within needs assessment, preclinical research, product development, clinical trials, postmarket follow up studies or health technology assessment.Moreover, an intensified collaboration between clinicians across hospitals and countries benefits the innovation of clinical procedures through the exchange of best practice, influenced by different national, organisational and regulatory conditions. Finally, successful innovation is driven by fast market access across countries which can be facilitated by collaboration between clinicians and companies, which is especially relevant for start-ups and SMEs in the NSR.The challenge is to improve the outcome of fracture treatment regarding functioning, co-morbidities and health as well as socio-economic costs. A key is a better understanding of fracture healing and of the benefits of personalised implants, optimised treatment and management of fracture care in North Sea Region countries.