Table 1 Properties for a bone adhesive modified from “Bone adhesives for trauma surgery: A review of challenges and developments,” by Farrar, 2012, International Journal of Adhesion and Adhesives, 33:89–97 [2], with the additional proposed requirements for successful percutaneous injection

• High level of adhesion to bone, often in the presence of contaminants such as fats, proteins, etc.

• Bonds to wet surfaces/bond strength stable in wet environment

• Mechanical stability under tension, compression, shear

• Easy/quick to prepare and apply in operating room conditions

• Adequate working time for the surgeon to apply and form bone

• Rapid setting time (typically 1–10 min)

• Low exotherm on setting – no thermal necrosis

• Non-toxic and biocompatible (including any leachables, degradation products, etc.)

• Allows healing of the fracture

• Sterilisable

• Adequate shelf-life

• Cost effective to use

• Commercially viable to manufacture

• Adhesion to surgical allows (e.g. stainless steel, Ti-6Al-4 V, Co-Cr-Mo, etc.)

• Biodegradable in a controlled manner and timescale

• No special storage conditions (stable at room temperature)

• Ability to deliver drugs/bioactive agents e.g. stimulate bone healing, prevent infection, etc.

• Addition of fluoroscopic-compatible agents

• Not overly viscous to block or slow application through the needle

• Adequate working time for the surgeon to inject the adhesive

• Compatible with use in conjunction with local anesthetic.

• Maintains sterility through the process of injection.

• Osteoinductive and osteoconductive properties