The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

Abstract

Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this ''graft expansion rationale.'' There were 45 patients (32 male) with a median age of 43 years (range, 19-76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12-65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1-7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3-14 months) and 6 months (range, 4-16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3-6 months). The median visual analog scale pain score was 0.9 (range, 0-2.8; maximum 10), and the median functional score was 86 (range, 67-95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients.

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

“…On the other hand, this literature research also revealed that most of the clinical findings are based on case reports or case series with small patient populations, characterized by different delivery approaches, anatomical locations, bone pathologies and dosages, which makes it difficult to draw any final conclusion about the real potential of BMPs therapy and the best protocol they can be applied to [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Therefore, further research in this direction is needed.…”

“…Among the 6.2 million fractures occurring annually in the United States, 5 to 10% on average develop into delayed unions or non-unions with great expenditure for the national health system in terms of costs and work force loss [47]. In this scenario, BMPs have been suggested as a promising treatment approach for bone repair, since they are considered the most potent osteoinductive agents [68].…”

Long-term safety and efficacy of human bone morphogenetic protein (HBMP) in the treatment of resistant non-unions and failed arthrodesis

“…Additionally, studies directed specifically at the use various recombinant BMPs have failed to show an association with the development of tumor induction, systemic toxicity, or allergic reaction to BMP in a short-term or intermediate-term follow-up period. 2,6,8,10,12,14,[16][17][18][19] Furthermore, several studies have shown that the use of hBMP in the treatment of non-unions and acute open fractures may be associated with a decreased risk of infection compared to control groups. 7,12 Although the mechanism for this has not been fully elucidated, researchers suggest that this may be linked to the positive effect that BMPs exert on the local cellular environment and the vascularity by stimulating angiogenesis at the fracture site.…”

“…10 The osteoinductive properties of BMP have been well documented to not only enhance the amount of new bone formed, but to increase the rate at which fracture healing occurs. 2,11,12 As a result, the use of BMP in bone fusion and spinal arthrodesis continues to increase in volume.…”

Klavikula kaynamamaları

“…Rekombinan kemik morfojenik proteini (BMP) hem hayvan hem klinik çalışmalarla geliştirilmiş ve başarıy-la kullanılmıştır. [31,32] Klavikula kaynamamaları ile ilgili mevcut literatür bilgisi yetersiz olmakla beraber, atrofik kaynamamalarda biyolojik destek amaçlı makul bir seçenek olabilir.…”