Partially adhesive fixation of reconstruction plates at midfacial fractures – an alternative solution to screw fixation?

Abstract

For the prognosis and long-term stability of an implant, for example a hip-or knee-implant, the anchorage to the bone is of critical importance. Normally for this anchorage bone cement is used, which achieves sufficient retention to spongious bone structure. If there is the need for osteosynthesis of midfacial fractures for surgical therapy, in some situations it would be clinically preferable to fix the reconstruction plates without the usual system using screws. This is the aim of the new adhesive fixing technology which is presented in this article. The structure of bone in midface, however, is cortical and such a smooth surface will allow only insufficient retention forces between bone and bone cement. In order to obtain a good adhesion at cortical bone nevertheless, we have to apply a bone bonding agent similar to techniques used in dentistry, which are based on dentin bonding agents, because there are different wetting properties of the hydrophilic bone and the hydrophobic bone cement monomers.Determination of achievable bond strength was done in a tension test ex vivo. Reconstruction plates were fixed with bone cement at bovine bone conditioned with a bone bonding agent developed for this field of application. With bond strengths up to 6 MPa it is assumed that an adhesive fixation of reconstruction plates at cortical bone structure is possible using the developed amphiphilic bone bonding agent.

A polyurethane‐based nanocomposite biocompatible bone adhesive

“…However, unique challenges are present in the bonding of biological material in the in vivo conditions. Primary among these is the interface where hydrophobic polymer and hydrophilic bone come into contact 8. To overcome the incompatibility between polymers and bone, an amphiphilic primer can be used to modify the surface energy.…”

Histopathologic Effects of Glass Ionomer Bone Cements Application to Maxillofacial Area: An Experimental Study in Rabbits

“…Among these alternatives, wire fixation, bicortical miniplates, and compressive and noncompressive miniplate systems are reliable options for rigid fixation (8,13,15). An ideal alloplastic material for maxillofacial reconstruction should be biocompatible, available in sufficient quantities, strong enough, and easy to shape to fit the defect and regional anatomy, easily fixable, not prone to migration, and bioresorbable with minimal foreign body reaction (1,15). Miniplate systems are expensive, and except for biodegradable miniplates, reoperation is needed for removal (8).…”

“…Although there was some decrease in radiologic density of the obliteration material over time, they reported the material to be well tolerated with no loss of volume. Smeets et al (15) stated that, for clinical application of reconstruction plates, the dentine bone bonding agent has the advantage of providing an alternative fixing technique for the plates if fixing with screws is impossible. they showed achievable bond strength in a tension test with this material.…”

A new adhesive technique for internal fixation in midfacial surgery

“…One promising alternative seems to be the use of adhesive systems for internal fixation that were already described in numerous in vitro and in vivo studies [ 1 , 3 , 13 - 16 ]. According to this studies it could be concluded that adhesive systems might be a useful alternative in bone bonding [ 3 ].…”

“…According to this studies it could be concluded that adhesive systems might be a useful alternative in bone bonding [ 3 ]. Thus, gluing is an attractive technique to fix bone fragments in orthopaedic and trauma surgery providing several advantages compared to nailing or screwing [ 1 , 16 , 17 ]. Therefore several preconditions have to be met by a bone adhesive for its all day clinical use.…”