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Bone and tissue adhesives are common supplements to sutures in surgical practice today. Some of these adhesives are called tissue glues (or sealants), which suggests that they possess strong adhesive properties they were originally not intended to have.1 Whereas a sealant provides a protective covering and a sufficient bond between 2 surfaces, an adhesive can robustly bond these 2 surfaces in an enduring manner. The differences between the 2 are often unclear despite their similar application.2 However, recent literature demonstrates their increasing adjunct or primary use in repair of musculoskeletal soft tissues and chondral and osteochondral fractures.
The clinical use of bone glue by orthopedic surgeons, especially in orthopedic trauma surgery, may be becoming more of a reality.3 Currently, bone adhesives are used for fixation of avulsion fractures and bony fragments, for fractures with minimal soft tissue exposure (eg, metacarpal, metatarsal, and phalanges), and especially for highly comminuted fractures that often comprise many small fragments.4,5 In addition, they have been used for periprosthetic fracture fixation. Using an adhesive allows for peak load transfer in fracture fixation, creating a firm union through the entire surface of the fracture as opposed to focal spot weld contacts made when using fixation devices such as pins.4
Adhesives prevent gap formation and do not restrict intrinsic blood supply in musculoskeletal tissues, which can have detrimental effects on healing of soft tissues, such as in tendon repair.6,7 There is no need to remove hardware that may become painful. Currently, no true bone glue--like epoxy exists. There are various bone cements and void fillers, the best of which is polymethylmethacrylate (PMMA) bone cement, which acts as a filling between bone and a prosthetic implant when used for fixation.3
Certain inherent features are preferred for optimal use of an adhesive in orthopedic surgery. The adhesive must be able to bond to bone with a useful strength, which Weber and Chapman8 suggest to be greater than 0.2 MPa. Below this strength, fixation strength is untenable. It requires a capability to sustain its bond long enough to allow for the fracture to adequately heal, which can take up to 3 months, if not longer. Thus, it is vital that this adhesive, when applied in and around...