Bone Adhesives in Trauma and Orthopedic Surgery

ArticleinEuropean Journal of Trauma 32(2):141-148 · April 2006with84 Reads
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.
    • Of particular interest is the chemical modification of DOPA2021222324252627282930. In an effort to take advantage of the adhesive properties of DOPA, many researches have been focused on the synthesis and characterization of DOPA-containing polymers2122232425. However, the cross-linking of the DOPA-containing compounds was typically performed by oxidation of DOPA moiety to form DOPA-quinone, which engaged in intra/intermolecular curing reactions to produce a gel network.
    [Show abstract] [Hide abstract] ABSTRACT: For underwater adhesives with biocompatible and more flexible bonds using biomimetic adhesive groups, DOPA-like adhesive molecules were modified with cyanoacrylates to obtain different repeating units and chain length copolymers. The goal of this work is to copy the mechanisms of underwater bonding to create synthetic water-borne underwater medical adhesives through blending of the modified DOPA and a triblock copolymer (PEO-PPO-PEO) for practical application to repair wet living tissues and bones, and in turn, to use the synthetic adhesives to test mechanistic hypotheses about the natural adhesive. The highest values in stress and modulus of the biomimetic adhesives prepared in wet state were 165 kPa and 33 MPa, respectively.
    Full-text · Article · Oct 2014
    • This tissue adhesive can be used to provide support after anastomosis in combination with prevention of leakage [55,70]. Polyurethanes are also being used for bone fixation, hemostasis and sealing of vascular grafts in several surgery procedures717273. Vascular grafts are slightly permeable for blood, causing leakage of blood into the body.
    [Show abstract] [Hide abstract] ABSTRACT: Each year millions of people sustain traumatic or surgical wounds, which require proper closure. Conventional closure techniques, including suturing and stapling, have many disadvantages. They inflict additional damage on the tissue, elicit inflammatory responses and have a relatively long application time. Especially for the more demanding wounds, where fluids or gasses are to be sealed off, these techniques are often insufficient. Therefore, a large variety of tissue adhesives, sealants and hemostatic agents has been developed. This review provides an overview of such tissue adhesive materials from a polymer chemistry perspective. The materials are divided into synthetic polymer-based, polysaccharide-based and protein-based adhesives. Their specific properties and behavior are discussed and related to their clinical application. Though each type has its specific advantages, yet few have become standard in clinical practice. Biomimetic based adhesives and other novel products have shown promising results but also face specific problems. For now, the search for better adhering, stronger, easier applicable and cheaper adhesives continues and this review is intended as starting point and inspiration for these future research efforts to develop the next generation tissue adhesives.
    Full-text · Article · Jul 2014
    • 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.
    [Show abstract] [Hide abstract] 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.
    Full-text · Chapter · Jan 2013 · Acta biomaterialia
    • However, cyanoacrylates degrade reactively in aqueous media and resulting traces of formaldehyde can cause more tissue irritations in certain applications than less reactive materials, such as the naturally formed fibrin adhesives4567. Due to the poor mechanical properties of cured fibrin adhesives [3,8910 numerous adhesives based on epoxides [11, 12] , polyure- thanes131415, polymethacrylates [11, 12] , gelatin–resor- cinol–aldehydes [3, 16], proteinaldehydes [17], mussel adhesive proteins [18, 19] as well as oligo-and polylac- tones [20, 21] have been developed. In order to generate a biodegradable soft tissue adhesive with higher adhesive strength than fibrin glue and an enhanced biocompatibility in comparison to the cyanoacrylates, we previously synthesized an isocyanate-functionalized 1,2-ethylene glycol bis(dilactic acid) (abbreviated as ELA-NCO) characterized by NMR and FTIR spectroscopy and rheological mea- surements [22].
    [Show abstract] [Hide abstract] ABSTRACT: Biodegradability and adhesive-associated local drug release are important aspects of research in tissue adhesive development. Therefore, this study focuses on investigating the in vitro degradation and drug release of a tissue adhesive consisting of hexamethylene diisocyanate functionalized 1,2-ethylene glycol bis(dilactic acid) and chitosan chloride. To prevent infections, ciprofloxacin hydrochloride (CPX·HCl) was incorporated into the adhesive. The influence of CPX·HCl on the adhesive reaction and adhesive strength was analyzed by FTIR-ATR-spectroscopy and tensile tests. The CPX·HCl release was investigated by HPLC. The degradation-induced changes at 37 °C were evaluated by gravimetric/morphological analyzes and micro-computer tomography. The antibiotic potential of the CPX·HCl loaded adhesive was determined by agar diffusion tests. The degradation tests revealed a mass loss of about 78 % after 52 weeks. The adhesive reaction velocity and tensile strength were not influenced by CPX·HCl. Using a 2 mg/g CPX·HCl loaded adhesive an inhibition of all tested bacteria was observed.
    Full-text · Article · Dec 2012
    • – Polyurethane [182,185,186] – Preventing the seroma formation in abdominoplasty – A lysine derived sprayable urethane adhesive (TissuGlu ® ) [187] Biomimetic adhesives Marine mussel extract – Repair of gestational fatal membrane ruptures – Catechol functionalized PEG (cPEG) whose molecules crosslink into a hydrogel after addition of sodium periodate [245] – Islet transplantation at extrahepatic sites – cPEG adhesive [244] – Prosthetic mesh fixation – Amphiphilic block copolymers constructed from PEG and polycaprolactone modified with 2 DOPA derivatives and with dopamine and DOA [243] Gecko inspired – Sealing wounds and for suture and staple replacement.
    [Show abstract] [Hide abstract] ABSTRACT: Due to several advantages over traditional approaches (e.g. sutures and staples), surgical adhesives are excellent materials for wound closure. For several decades intensive research activities have been carried out to enhance the efficiency of the adhesives in different tissues and application conditions. This article provides a concise literature review of different types of adhesives in order to understand their structure–properties relationship. Some of the most important commercial adhesives available are presented and discussed in terms of limitations and applications. The recent advances reported in the literature that could provide new avenues to the development of more efficient adhesives inspired in nature strategies are also discussed.
    Full-text · Article · Aug 2012
    • Injectable degradable flexible bone cement and adhesives, however, could rubber-toughen brittle bone and aid early screw anchorage. Moreover, if sufficiently strong they could, in lower load bearing applications, replace the screw thereby reducing site preparation requirements and hence damage [6]. Polymethylmethacrylate (PMMA) is the most commonly used bone cement [7].
    [Show abstract] [Hide abstract] ABSTRACT: The aim of this study was to investigate the effect of reactive mono- and tricalcium phosphate addition on the mechanical, surface free energy, degradation and cell compatibility properties of poly(lactide-co-propylene glycol-co-lactide) dimethacrylate (PPGLDMA) thin films. Dry composites containing up to 70 wt.% filler were in a flexible rubber state at body temperature. Filler addition increased the initial strength and Young's modulus and reduced the elastic and permanent deformation under load. The polymer had high polar surface free energy, which might enable greater spread upon bone. This was significantly reduced by filler addition but not by water immersion for 7 days. The samples exhibited reduced water sorption and associated bulk degradation when compared with previous work with thicker samples. Their cell compatibility was also improved. Filler raised water sorption and degradation but improved cell proliferation. The materials are promising bone adhesive candidates for low-load-bearing areas.
    Full-text · Article · Aug 2011
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