Bone Adhesives in Trauma and Orthopedic Surgery

University of Gießen—Marburg Department of Trauma Surgery Rudolf-Buchheim-Strasse 7 35385 Gießen Germany Rudolf-Buchheim-Strasse 7 35385 Gießen Germany
European Journal of Trauma 03/2006; 32(2):141-148. DOI: 10.1007/s00068-006-6040-2

ABSTRACT Adhesives, especially bone adhesives, are resorbed and degraded to non-toxic products after fulfilling their function in contact
with the living organism. The use of such bone adhesives has found growing interest in all fields of medicine in the last
50 years. The dream of trauma and orthopedic surgeons for alternatives to osteosynthesis and pins is reflected in the development
of a variety of surrogates of biological or synthetic origin. Despite a longstanding history of research in this field up
to now a clinically applicable alternative could not have been found on the field of bone gluing. The application consistently
collapsed, because these adhesives were not tailored to the conditions met within the living organism. The following article
is meant to provide an overview of the development, the state of the art and today’s knowledge of bone adhesives. In addition,
the article wants to pinpoint the tremendous progress made on this subject, made possible by the joint effort of basic researchers
and surgeons. The results show that in the future a successful reconstructive surgery will emerge from the application of
synthetic biomaterials.

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    • "Polyurethanes have characteristics that allow them to be considered as strong candidates to be used in situ, such as: high wettability properties with the majority of substrates; interact with the substrate by polar interactions (hydrogen bonds); ability to covalent bond with substrates with hydrogen atoms (when urethane pre-polymers are used) and by tailoring the molecular composition, the crosslinking degree and stiffness, urethanes can be moulded according to the desired application. Polyurethane pre-polymers were first used as biological adhesives in 1959 for the fusion of bone fragments (Heiss et al., 2006). This adhesive, commercially named as Ostamer ® , was composed by a pre-polymer and a catalyst which were mixed priory to application. "
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    ABSTRACT: A wound may be defined as an injury to any of the body's tissues, especially one caused by physical means and with interruption of continuity. Primary wound healing of a plan-to-plan oriented scar formation is usually accomplished by hand sewing or stapling the corresponding layers of each side of the incision. Both these methods have been associated to wound infection and granule formation due to their degradation in the organism. They also present other disadvantages, such as the need to be removed (in most cases) and the pain associated with their use. As a result of these shortcomings, surgeons have thought of an alternative way: the use of medical tissue adhesives. These adhesives consist on an attractive option to suturing or stapling since they can accomplish other tasks, such as haemostasis and the ability of sealing air leakages and also because they do not represent any risk of needlestick injury to medical staff. Also, the use of an adhesive would reduce the surgeries procedure time since its application presents itself as an easier and faster method to establish tissue adhesion. Despite their advantages, surgical adhesives must obey some clinical requirements. They must hold the two sides of the tissue together until it is no longer necessary, and then they should be degraded to biocompatible products. The most used surgical glues nowadays are the fibrin based adhesives and cyanoacrylates. Fibrin based adhesives present several problems, e.g. immunogenicity and risk of blood transmission diseases such as HIV and BSE. On the other hand, cyanoacrylates have been reported to degrade in aqueous media producing formaldehyde, which causes inflammation and has carcinogenic potential. Other options are now coming into light, and among the synthetic materials, urethane-based adhesives have been considered to be the most promising. These materials may be prepared under the form of pre-polymers (containing free isocyanate groups) and therefore being able to react with amino groups present in the biological molecules establishing adhesion. Another current area of research is the synthesis of UV-curable adhesives. These offer major advantages compared to pre-polymers systems, such as fastcuring rate, control of polymerization heat evolution and are ideal for application to weakened and diseased tissue. Throughout this chapter, examples of currently applied bioadhesives in surgery, as well as their advantages and disadvantages will be described. A special emphasis will be given to the development of polyurethane based adhesives both in the pre-polymer and UV-curable forms.
    Biomedical Polyurethane-Based Materials, 01/2013; Nova Publishers, New York., ISBN: 978-1-61942-453-1
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    • "Former applications failed, because these adhesives were not tailored to the conditions met within the living organism [12]. However, the importance of this issue will persist into be more in the future and more studies about biocompatibility and bond strength of new bone adhesives will follow [12]. "
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    ABSTRACT: The current surgical therapy of midfacial fractures involves internal fixation in which bone fragments are fixed in their anatomical positions with osteosynthesis plates and corresponding screws until bone healing is complete. This often causes new fractures to fragile bones while drilling pilot holes or trying to insert screws. The adhesive fixation of osteosynthesis plates using PMMA bone cement could offer a viable alternative for fixing the plates without screws. In order to achieve the adhesive bonding of bone cement to cortical bone in the viscerocranium, an amphiphilic bone bonding agent was created, analogous to the dentin bonding agents currently on the market. The adhesive bonding strengths were measured using tension tests. For this, metal plates with 2.0 mm diameter screw holes were cemented with PMMA bone cement to cortical bovine bone samples from the femur diaphysis. The bone was conditioned with an amphiphilic bone bonding agent prior to cementing. The samples were stored for 1 to 42 days at 37 degrees C, either moist or completely submerged in an isotonic NaCl-solution, and then subjected to the tension tests. Without the bone bonding agent, the bonding strength was close to zero (0.2 MPa). Primary stability with bone bonding agent is considered to be at ca. 8 MPa. Moist storage over 42 days resulted in decreased adhesion forces of ca. 6 MPa. Wet storage resulted in relatively constant bonding strengths of ca. 8 MPa. A new amphiphilic bone bonding agent was developed, which builds an optimizied interlayer between the hydrophilic bone surface and the hydrophobic PMMA bone cement and thus leads to adhesive bonding between them. Our in vitro investigations demonstrated the adhesive bonding of PMMA bone cement to cortical bone, which was also stable against hydrolysis. The newly developed adhesive fixing technique could be applied clinically when the fixation of osteosynthesis plates with screws is impossible. With the detected adhesion forces of ca. 6 to 8 MPa, it is assumed that the adhesive fixation system is able to secure bone fragments from the non-load bearing midfacial regions in their orthotopic positions until fracture consolidation is complete.
    BioMedical Engineering OnLine 02/2008; 7:16. DOI:10.1186/1475-925X-7-16 · 1.43 Impact Factor
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    ABSTRACT: Nature has been developing adhesives for millions of years, mankind for just a few thousands of years. For this reason it is worth having a closer look at what nature does and how we can develop bio-inspired adhesives for technical and medical applications. Some examples of natural materials which have already been used for technical adhesives are casein, latex rubber, tree gum, and adhesives derived from natural sources used for the waterproofing of natural textiles, the production of paper, and the sealing of jars (Papov et al., 1995; Creton and Papon, 2003). Bio-inspired adhesives can be found in all areas of the natural world. Because of their origin, those adhesives are also called biological adhesives or bioadhesives and they fulfill several different functions (Smith and Callow, 2006; Carrington, 2008; Antonietti and Fratzl, 2010). Plants use adhesives, for example, for self-healing and for protecting themselves against wood defects, while animals use sticky materials for protecting themselves against predators and for hunting prey (Keckes et al., 2003; Schreiber et al., 2005; Flammang, 2006; Voigt and Gorb, 2008; Plaza et al., 2009). Microorganisms use adhesive material for settlement, surface attachment, and colonization (Melzer et al., 2008; Flammang et al., 2009; Santos et al., 2009; Scholz et al., 2009). Higher organisms, such as humans, rely on an inducible adhesive system: the wound healing promoter fibrinogen ((Berlind et al., 2010), which is discussed in detail in Chapter 15, p. 225 of this book).
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