Emerging bone adhesives for early fixation and enhanced healing of fractures

Fractures are prevalent in clinical orthopedics. Conventional metal implants used for fracture fixation pose risks of iatrogenic injury and infection, and often fail to achieve precise alignment in complex cases. Bone adhesives represent a promising alternative, as they can accommodate the fixation requirements of various complex fractures while circumventing many of the issues associated with metallic fixation. However, currently available clinical adhesives often fail to meet the complex requirements of bone tissue adhesion. Therefore, there is an urgent need to develop novel bone adhesives that align more closely with clinical demands. This review systematically elucidates the key properties requisite for bone adhesives and offers an in-depth discussion on design strategies focused on interfacial adhesion, mechanical strength, degradability, and biological performance. Furthermore, this article summarizes the evaluation criteria for assessing the clinical applicability and translational potential of bone adhesives. This review aims to establish a comprehensive understanding of the essential criteria for bone adhesives and to provide systematic guidance for their rational design. Ultimately, this will accelerate the development of high-performance novel adhesives and propel advancements in fracture management.