Moldable self-setting and bioactive bone wax for bone hemostasis and defect repair.

Abstract

Objective: Bone injury complicated with bleeding and irregular shaped defect are challenging in orthopedic surgery and practices due to the lack of reliable hemostasis and simultaneous defect repair strategy. Bone wax is a century-old biomaterial for bleeding management in orthopedic surgery, characterized with ready-to-use advantage but the risk of failed bone reunion due to the biological inertness and non-degradability. In current work, integration of bioceramic cement and premixed concept was motivated to prepare a in situ self-setting bioactive calcium phosphate based bone wax (CaPBW) for bone hemostasis and defect repair.

Methods: A moldable, in situ self-setting bioactive CaPBW with a novel formulation of calcium phosphate cement (CPC), monetite (DPCA) granules, modified starch and polyethylene glycol (PEG) was developed for bone hemostasis and defect repair. The CaPBW material was evaluated by characterization, physical and chemical properties, biocompatibility, osteogenic ability and hemostatic ability.

Results: CaPBW adopted the ready-to-use feature of traditional bone wax, showing feasibility in shape molding and defect sealing. When interacted with physiological fluid like blood, CaPBW could transformed from putty to solid state within tens of minutes due to the gradual PEG-water exchange and CPC hydration, providing mechanical stability for bleeding clotting and bone defect filling. In vitro studies revealed the superiority of CaPBW over bone wax in blood coagulation and osteoblast differentiation, along with hemocompatibility and osteogenesis confirmation. In vivo studies demonstrated the reliability of CaPBW in hemostasis and bone regeneration compared to traditional bone wax, promoting the efficacy of bone bleeding and new bone formation.

Conclusion: As compared to traditional bone hemostatic agent bone wax, CaPBW not only preserved its advantages in handling and defect sealing, but also provided platform for temporary physical support and bone regeneration acceleration.

The translational potential of this article: The integrated design of osteogenesis and hemostasis makes CaPBW have the dual functions as bone hemostasis material and artificial bone substitute. CaPBW therefore demonstrates a strategy of next-generation bone wax with high translational potential for orthopedic surgery.