TISSUES AND BONE ADHESIVES - HISTORICAL ASPECTS

Glues and adhesives attach to a surface principally involving molecula r attraction, whereas cements mostly work through mechanical interlock ing. The adhesive and its degradation products must be biocompatible: chemical, clinical, legal, physical aspects are considered; the toxici ty of even minor components must be extremely reduced. The idea of bon e bonding using biological materials has been proposed by Gluck, in Be rlin, more than a century ago. Cements and adhesives have been used fo r the fixation of fractures, the repair of defects and the fixation of prostheses. The cements are initially liquid or plastic and conform w ith the irregularities in the substratum, producing better bonding on rough surfaces. Developed during the early 1950s, cyanocrylate adhesiv es attracted the medical community by their bonding strength and abili ty to bond in wet environments but reports of displacement of the frac ture ends were followed by reports of high infection rates, nonunion, and severe local reactions. Polymethylmethacrylate does not form a che mical bond with bone but a mechanical bond, a weak bone-polymer joint. Charnley used self-curing acrylic cement to bond a femoral head prost hesis into a femur. When adhesives are used to bond tissues, the polym er 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 b een 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 tra uma. (C) 1998 Elsevier Science Ltd. All rights reserved.