Treatment of a congenital pseudarthrosis of the tibia by osteogenic protein-1 (bone morphogenetic protein-7): a case report

Antičević, Darko; Jelić, Mislav; Vukičević, Slobodan

doi:10.1097/01.bpb.0000194439.75378.ac

Cited by 37 publications

(26 citation statements)

References 3 publications

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“…However, the reported results are contradictory. In two case reports, successful osteosynthesis was achieved 23,24 , but in a case series of five patients with congenital pseudarthrosis of the tibia who were treated with rhBMP-7 and intramedullary rods or external fixation, unequivocal union was achieved only in one patient 25 . The in vitro data obtained during the present study suggest that BMP treatment may not induce fibrous hamartoma cells to differentiate to osteoblasts.…”

Section: Discussionmentioning

confidence: 99%

Biologic Characteristics of Fibrous Hamartoma from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type 1

Cho

Seo

Lee

et al. 2008

The Journal of Bone and Joint Surgery-American Volume

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Section: Discussionmentioning

confidence: 99%

Biologic Characteristics of Fibrous Hamartoma from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type 1

Cho

Seo

Lee

et al. 2008

The Journal of Bone and Joint Surgery-American Volume

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“…There are over 30 of them, but only two have been developed for application in mankind and produced by genetic engineering: the recombining BMP2 and BMP7. The use of rhBMP in pseudarthrosis of the tibia seems promising in the light of initial observations published about children [12][13][14][15][16][17][18]45] and the results obtained in adults [1,2]. In children, the question arises as to the early and long-term side effects.…”

Section: Application Of Bmpmentioning

confidence: 99%

“…The results obtained using BMPs in adults, particularly in the case of pseudarthrosis of long bones, have opened up the perspective of applying these proteins to children in certain highly complex situations. A few authors have reported their experience in compassionate indications, especially CPT [12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: A case series and meta-analysis

Dohin

Köhler²

2012

Journal of Children's Orthopaedics

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Purpose A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect. Method The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated. Results In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology. Conclusion The authors confirmed that segmental bone reconstruction is possible in CPT using Masquelet's procedure. In the literature, the success rate of the application of rhBMP in CPT appears to be lower than the healing rate usually reported without BMP. Nevertheless, the strict selection of patients, limited number of cases, and their heterogeneity make interpreting the results difficult. However, the theoretical risk which the children are exposed to during the use of BMP makes rigorous selection of the indications necessary. Finally, the interest of rhBMP2 application in Masquelet's procedure remained to be proven.

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“…In addition to the United States, OP-1 has been approved in 28 other countries, including Canada, Australia, and the European Union [27]. Although contraindicated in children, BMPs have been used off-label in some difficult nonunions in children [2,7,11,20,23]. In these cases, the benefits of using BMPs may outweigh the abovementioned concerns.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of Difficult Nonunion in Children with Osteogenic Protein-1 (OP-1): Early Experience

Dohin

Dahan‐Oliel

Fassier

et al. 2009

Clin Orthop Relat Res

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Numerous studies have described the use of osteogenic protein-1 (OP-1) in adults, but there are few reports in children. The objectives of this short-term followup cohort study were (1) to examine clinical and radiographic healing of persistent nonunions after OP-1 application in children; and (2) to determine the safety of OP-1 use in this sample. Clinical healing was defined by absence of pain and tenderness at the nonunion site and the ability to fully weight bear on the affected limb. Radiographic healing was determined by bony bridging of the nonunion site in at least one view. Safety was defined as the absence of major adverse events, including allergic reactions, infections, local inflammatory reactions, and heterotopic ossification. OP-1 was used in 19 patients who had an operative procedure for the bridging of persistent nonunions between 1999 and 2007. The mean age was 11.6 years (range, 4.8-20.3 years). Thirteen patients had persistent nonunion after one or more previous surgeries, prior to the initial OP-1 application. A single dose of 3.5 mg of OP-1 mixed with 1 g of Type I bovine collagen was applied to 23 sites of 19 patients. Three patients received additional OP-1 applications. Healing occurred clinically and radiographically in 17 of the 23 sites. Complications included four superficial pin site infections, one deep infection, and two fractures. No major local adverse event related to OP-1 application was noted in our sample. Our findings suggest OP-1 stimulates healing of persistent nonunions without major adverse events in our patient population. Level of Evidence: Level IV, case series. See the guidelines online for a complete description of levels of evidence.

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Treatment of a congenital pseudarthrosis of the tibia by osteogenic protein-1 (bone morphogenetic protein-7): a case report

Cited by 37 publications

References 3 publications

Biologic Characteristics of Fibrous Hamartoma from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type 1

Biologic Characteristics of Fibrous Hamartoma from Congenital Pseudarthrosis of the Tibia Associated with Neurofibromatosis Type 1

Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: A case series and meta-analysis

Enhancement of Difficult Nonunion in Children with Osteogenic Protein-1 (OP-1): Early Experience

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