Abstract
AbstractOpen reduction internal fixation (ORIF) metal plates provide exceptional support for unstable bone fractures; however, they often result in debilitating soft‐tissue adhesions and their rigid shape cannot be easily customized by surgeons. In this work, a surgically feasible ORIF methodology, called AdhFix, is developed by combining screws with polymer/hydroxyapatite composites, which are applied and shaped in situ before being rapidly cured on demand via high‐energy visible‐light‐induced thiol–ene coupling chemistry. The method is developed on porcine metacarpals with transverse and multifragmented fractures, resulting in strong and stable fixations with a bending rigidity of 0.28 (0.03) N m2 and a maximum load before break of 220 (15) N. Evaluations on human cadaver hands with proximal phalanx fractures show that AdhFix withstands the forces from finger flexing exercises, while short‐ and long‐term in vivo rat femur fracture models show that AdhFix successfully supports bone healing without degradation, adverse effects, or soft‐tissue adhesions. This procedure represents a radical new approach to fracture fixation, which grants surgeons unparalleled customizability and does not result in soft‐tissue adhesions.
Highlights
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A surgically feasible Open reduction internal fixation (ORIF) methodology, called AdhFix, is developed by combining screws with polymer/hydroxyapatite composites, which are applied and shaped in situ before being rapidly cured on demand via high-energy visible-light-induced thiol–ene coupling chemmobility in phalangeal fractures fixated with metal plates is as high as 64%.[8]
thiol–ene coupling (TEC) thermosets A1 and B1 were formulated with TATO alkene and either TATO thiol A or its ester-free equivalent TATO thiol B, respectively, together with diphenyl(2,4,6-trimethylbenzoyl) phosphine oxide (TPO) as a photoinitiator
Summary
TEC thermosets A1 and B1 were formulated with TATO alkene and either TATO thiol A or its ester-free equivalent TATO thiol B, respectively, together with diphenyl(2,4,6-trimethylbenzoyl) phosphine oxide (TPO) as a photoinitiator. TATO thiol B was chosen as an alternative to TATO thiol A, as it was expected that the ester bonds of the latter would promote the absorption of water and impair the mechanical performance of its materials under physiological conditions.[24,25] Composites were made from these thermosets by adding 56 wt% of either HA (A2 and B2) or alkene-functionalized HA particles (HA–ene) (A3 and B3) (Figure 1b). With the TATO thiol B materials, it had a positive effect, as the B3 composite was the stiffest material of the six tested, with a modulus of 7.5 (0.3) GPa. B3 had high glass-transition and onset temperatures, at 89 (1) and 62.9 (0.7) °C, and a strength of 72 (3) MPa (Figure S2b, Supporting Information). The water absorption values of the A1–A3 materials at 37 °C were approximately twice those of their B1–B3 equivalents, due to the presence of ester functionalities in TATO thiol A (Figure S2c, Supporting Information). The rigidity and strength of the B1–B3 materials were more robust in wet conditions, with B2 and B3 decreasing in modulus by only 21% and 25% to 5.2 (0.3) and 5.64 (0.08) GPa, and in strength by 19% and 15% to 56 (2) and 61 (2) MPa, respectively
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