title: A new adhesive technique for internal fixation in midfacial surgery.
abstract: BACKGROUND
  The current surgical therapy of midfacial fractures involves internal fixation in which bone fragments are fixed in their anatomical positions with osteosynthesis plates and corresponding screws until bone healing is complete. This often causes new fractures to fragile bones while drilling pilot holes or trying to insert screws. The adhesive fixation of osteosynthesis plates using PMMA bone cement could offer a viable alternative for fixing the plates without screws. In order to achieve the adhesive bonding of bone cement to cortical bone in the viscerocranium, an amphiphilic bone bonding agent was created, analogous to the dentin bonding agents currently on the market.
  
  
  METHODS
  The adhesive bonding strengths were measured using tension tests. For this, metal plates with 2.0 mm diameter screw holes were cemented with PMMA bone cement to cortical bovine bone samples from the femur diaphysis. The bone was conditioned with an amphiphilic bone bonding agent prior to cementing. The samples were stored for 1 to 42 days at 37 degrees C, either moist or completely submerged in an isotonic NaCl-solution, and then subjected to the tension tests.
  
  
  RESULTS
  Without the bone bonding agent, the bonding strength was close to zero (0.2 MPa). Primary stability with bone bonding agent is considered to be at ca. 8 MPa. Moist storage over 42 days resulted in decreased adhesion forces of ca. 6 MPa. Wet storage resulted in relatively constant bonding strengths of ca. 8 MPa.
  
  
  CONCLUSIONS
  A new amphiphilic bone bonding agent was developed, which builds an optimizied interlayer between the hydrophilic bone surface and the hydrophobic PMMA bone cement and thus leads to adhesive bonding between them. Our in vitro investigations demonstrated the adhesive bonding of PMMA bone cement to cortical bone, which was also stable against hydrolysis. The newly developed adhesive fixing technique could be applied clinically when the fixation of osteosynthesis plates with screws is impossible. With the detected adhesion forces of ca. 6 to 8 MPa, it is assumed that the adhesive fixation system is able to secure bone fragments from the non-load bearing midfacial regions in their orthotopic positions until fracture consolidation is complete.
authors.affiliation: University Hospital Aachen, Dental Prosthetics Clinic, Medical Materials R&D Laboratory, Pauwelsstrasse 30, 52057 Aachen, Germany. kira.endres@medizinische-werkstoffe.de
authors.forename: Kira
authors.initials: K
authors.lastname: Endres
authors.forename: Rudolf
authors.initials: R
authors.lastname: Marx
authors.forename: Joachim
authors.initials: J
authors.lastname: Tinschert
authors.forename: Dieter Christian
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Christian
authors.initials: C
authors.lastname: Stoll
authors.forename: Dieter
authors.initials: D
authors.lastname: Riediger
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
mesh_terms: D000268:Adhesiveness; D000818:Animals; D001843:Bone Cements / Q000737:chemistry*; D001860:Bone Plates; D002417:Cattle; D005147:Facial Bones / Q000293:injuries / Q000601:surgery; D005264:Femoral Fractures / Q000503:physiopathology* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D016268:Internal Fixators; D008422:Materials Testing; D019904:Polymethyl Methacrylate / Q000737:chemistry*; D013718:Tensile Strength; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate