Bone glue - The final frontier for fracture repair and implantable device stabilization

Norton, Michael; Kay, George W.; Brown, Michael C.; Cochran, David L.

doi:10.1016/j.ijadhadh.2020.102647

Cited by 22 publications

(23 citation statements)

References 55 publications

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“…The translation from purely mechanical fixation through to biological fixation with an intermediate transition dip is broadly similar in character in healing fixation of a bone screw, dental implant fixation, soft tissue repair, and now in the behavior of the present bone core model. This consistent result is in contrast to the literature ( Cochran et al, 2020 ; Norton et al, 2020 ) reporting a similar TTCP+PSer-based adhesive which neither anticipates nor shows any strength dip.…”

Section: Discussioncontrasting

confidence: 93%

“…For the cancellous bone, a lower limit of 0.2 MPa has been suggested (Weber and Chapman, 1984), also a range of 0.5-1.0 MPa (Farrar 2012). Higher in vitro values are reported for bonding to the cortical bone, ranging from 3 MPa (Norton et al, 2020) to 9 MPa (Granskog et al, 2018). While greater strengths are in general desirable, the limiting factor will always be the weakest bone that is to be glued which in osteochondral bone fragments is the cancellous bone.…”

Section: Introductionmentioning

confidence: 99%

“…The mean removal torques were reported to be 22.2, 45.7, and 104.7 cmN at 24 h, 10 days, and 4 months, respectively. Norton et al (2020) reviewed preclinical model data for the TTCP+PSer adhesive and considered the properties that would qualify “bone glue” in the repair of simple and comminuted fractures. However, no published data that support the in vivo efficacy of a bone adhesive in cancellous bone repair have so far been presented over a clinically relevant time frame.…”

Section: Introductionmentioning

confidence: 99%

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Gluing Living Bone Using a Biomimetic Bioadhesive: From Initial Cut to Final Healing

Procter

Hulsart‐Billström

Alves

et al. 2021

Front. Bioeng. Biotechnol.

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Osteoporotic fractures are a growing issue due to the increasing incidence of osteoporosis worldwide. High reoperation rates in osteoporotic fractures call for investigation into new methods in improving fixation of osteoporotic bones. In the present study, the strength of a recently developed bone bioadhesive, OsStictm, was evaluated in vivo using a novel bone core assay in a murine animal model at 0, 3, 7, 14, 28, and 42 days. Histology and micro-CT were obtained at all time points, and the mean peak pull-out force was assessed on days 0–28. The adhesive provided immediate fixation to the bone core. The mean peak bone core pull-out force gradually decreased from 6.09 N (σ 1.77 N) at day 0 to a minimum of 3.09 N (σ 1.08 N) at day 7, recovering to 6.37 N (σ 4.18 N) by day 28. The corresponding fibrin (Tisseel) control mean peak bone core pull-out characteristic was 0.27 N (σ 0.27 N) at day 0, with an abrupt increase from 0.37 N (σ 0.28) at day 3, 6.39 N (σ 5.09 N) at day 7, and continuing to increase to 11.34 N (σ 6.5 N) by day 28. The bone cores failed either through core pull-out or by the cancellous part of the core fracturing. Overall, the adhesive does not interrupt healing with pathological changes or rapid resorption. Initially, the adhesive bonded the bone core to the femur, and over time, the adhesive was replaced by a vascularised bone of equivalent quality and quantity to the original bone. At the 42 day time point, 70% of the adhesive in the cancellous compartment and 50% in the cortical compartment had been replaced. The adhesive outwith the bone shell was metabolized by cells that are only removing the material excess with no ectopic bone formation. It is concluded that the adhesive is not a physical and biochemical barrier as the bone heals through the adhesive and is replaced by a normal bone tissue. This adhesive composition meets many of the clinical unmet needs expressed in the literature, and may, after further preclinical assessments, have potential in the repair of bone and osteochondral fragments.

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Section: Discussioncontrasting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gluing Living Bone Using a Biomimetic Bioadhesive: From Initial Cut to Final Healing

Procter

Hulsart‐Billström

Alves

et al. 2021

Front. Bioeng. Biotechnol.

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“…Bioresorbable bone adhesives may provide unprecedented clinical solutions in the fields such as trauma and orthopedic surgery, where bone repair, attachment, or reconstruction is involved in arthroplasty, vertebroplasty, and other procedures. [1,2,3] When they have suitable mechanical properties, bioresorbable adhesives could aid in fixing bone fractures instead of conventional plates, nails, pins and screws currently used in the clinic. The currently used hardware is associated with major drawbacks, including the need for removal after bone healing, refractures due DOI: 10.1002/adhm.202001058 to stress shielding, and difficulty to perform surgery for delicate fractures involving multiple small bone fragments.…”

Section: Introductionmentioning

confidence: 99%

Reinforcement and Fatigue of a Bioinspired Mineral–Organic Bioresorbable Bone Adhesive

Kirillova

Nillissen

Liu

et al. 2020

Adv Healthcare Materials

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Bioresorbable bone adhesives may provide remarkable clinical solutions in areas ranging from fixation and osseointegration of permanent implants to the direct healing and fusion of bones without permanent fixation hardware. Mechanical properties of bone adhesives are critical for their successful application in vivo. Reinforcement of a tetracalcium phosphate–phosphoserine bone adhesive is investigated using three degradable reinforcement strategies: poly(lactic‐co‐glycolic) (PLGA) fibers, PLGA sutures, and chitosan lactate. All three approaches lead to higher compressive strengths of the material and better fatigue performance. Reinforcement with PLGA fibers and chitosan lactate results in a 100% probability of survival of samples at 20 MPa maximum compressive stress level, which is almost ten times higher compared to compressive loads observed in the intervertebral discs of the spine in vivo. High adhesive shear strength of 5.1 MPa is achieved for fiber‐reinforced bone adhesive by tuning the surface architecture of titanium samples. Finally, biological and biomechanical performance of the fiber‐reinforced adhesive is evaluated in a rabbit distal femur osteotomy model, showing the potential of the bone adhesive for clinical use.

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“…Consequently, studies on products with minimal adhesive properties to bone tissue and products that are used to fill bone defects or as bone substitutes were excluded. This approach is different from other reviews on bone adhesives 9,10,[36][37][38][39] and is a more focussed and more specific review on the beneficial and adverse characteristics of animal models and bone-bonding materials in general.…”

Section: Effectiveness Of Bone Adhesives Compared To Conventional Met...mentioning

confidence: 98%

A systematic review and meta‐analyses on animal models used in bone adhesive research

Erk

Luijk²,

Yang

et al. 2021

Journal Orthopaedic Research

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Currently, steel implants are used for osteosynthesis of (comminuted) fractures and intra-articular bone defects. These osteosyntheses can sometimes be complicated procedures and can have several drawbacks including stress shielding of the bone. A bone glue might be a safe and effective alternative to current materials. Despite numerous animal studies on bone adhesives, no such material is clinically applied yet. We have conducted a systematic review to summarize the evidence in experimental animal models used in research on bone adhesive materials for trauma and orthopedic surgery. Additionally, we analysed the efficacy of the different bone adhesives for different experimental designs. A heterogeneity in experimental parameters including animal species, defect types, and control measurements resulted in a wide variety in experimental models. In addition, no standard outcome measurements could be identified. Meta-analysis on bone regeneration between adhesive treatment and nonadhesive treatment showed a high heterogeneity and no statistically significant overall effect (M: −0.71, 95% confidence interval [CI]: −1.63-0.21, p = 0.13). Besides, currently there is not enough evidence to draw conclusions based on the effectiveness of the individual types of adhesives or experimental models. A positive statistically significant effect was found for the adhesive treatment in comparison with conventional osteosynthesis materials (M: 2.49, 95% CI: 1.20-3.79, p = 0.0002). To enhance progression in bone adhesive research and provide valuable evidence for clinical application, more standard experimental parameters and a higher reporting quality in animal studies are needed.Statement of Clinical Significance: Current materials restoring anatomical alignments of bones have several drawbacks. A (biodegradable) adhesive for fixating bone defects can be a treatment breakthrough. Although numerous bone adhesives have been researched, most seemed to fail at the preclinical stage. An overview in this field is missing. This systematic review highlights the relevant parameters for design of experimental bone adhesive studies. It demonstrates evidence regardingThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Bone glue - The final frontier for fracture repair and implantable device stabilization

Cited by 22 publications

References 55 publications

Gluing Living Bone Using a Biomimetic Bioadhesive: From Initial Cut to Final Healing

Gluing Living Bone Using a Biomimetic Bioadhesive: From Initial Cut to Final Healing

Reinforcement and Fatigue of a Bioinspired Mineral–Organic Bioresorbable Bone Adhesive

A systematic review and meta‐analyses on animal models used in bone adhesive research

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