Tissues and bone adhesives--historical aspects

Glues and adhesives attach to a surface principally involving molecular attraction, whereas cements mostly work through mechanical interlocking. The adhesive and its degradation products must be biocompatible: chemical, clinical, legal, physical aspects are considered; the toxicity of even minor components must be extremely reduced. The idea of bone bonding using biological materials has been proposed by Gluck, in Berlin, more than a century ago. Cements and adhesives have been used for the fixation of fractures, the repair of defects and the fixation of prostheses. The cements are initially liquid or plastic and conform with the irregularities in the substratum, producing better bonding on rough surfaces. Developed during the early 1950s, cyanocrylate adhesives attracted the medical community by their bonding strength and ability to bond in wet environments but reports of displacement of the fracture ends were followed by reports of high infection rates, nonunion, and severe local reactions. Polymethylmethacrylate does not form a chemical bond with bone but a mechanical bond, a weak bone-polymer joint. Charnley used self-curing acrylic cement to bond a femoral head prosthesis into a femur. When adhesives are used to bond tissues, the polymer acts as a barrier between the growing edges and delay healing; the adhesive tends to be rapidly isolated from the bone by a fibrotic, non-adhesive capsule. No proof exists concerning the osteogenic potential of fibrin sealing (FS); its beneficial effect on bone formation has been questioned even if there is some evidence that FS should influence the early phases of bone repair and may help to solve the problem of reattachment of small osteocartilagenous fragments following joint trauma.