Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions

Overview

Journal J Clin Med

Specialty General Medicine

Date 2021 Oct 13

PMID 34640615

Citations 8

Authors

Thomas Fuchs

Josef Stolberg-Stolberg

Philipp A Michel

Patric Garcia

Susanne Amler

Dirk Wahnert

Michael J Raschke

Affiliations

Soon will be listed here.

Abstract

Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence for treatment effectiveness.

Questions: The objective of this study was to evaluate the effectiveness of rhBMP-2 treatment on long bone non-unions measuring union rate and time to union. Furthermore, we assess risk factors for treatment failure.

Methods And Patients: A total of 91 patients with non-unions of long bones were treated with rhBMP-2 ( = 72) or standard care without BMP ( = 19) at our institution. Patient characteristics, comorbidities, nicotine consumption, and complications were recorded. Bone healing was assessed by plane X-rays and clinical examination. Patients were followed up with for 24 months.

Results: Overall, there was significantly faster bone healing after rhBMP-2 application compared to the no-BMP group ( < 0.001; HR = 2.78; 95% CI 1.4-5.6). Union rates differed significantly between rhBMP-2 compared to the no-BMP group (89% vs. 47%; < 0.001). At the humerus, there was neither a significantly higher union rate in the rhBMP-2 (83%) compared to the no-BMP group (50%) ( = 0.26; = 12) nor a faster bone healing with a median time of 9 months in both groups (HR = 2.01; 95% CI 0.49-8.61; = 0.315). The 33 femora treated using rhBMP-2 healed significantly faster than 9 femora in the no-BMP group (HR = 2.93; 95% CI 1.00-8.4; = 0.023) with significant differences in union rate with 85% and 44%, respectively ( = 0.022). Regarding tibia non-unions, 25 out of 27 (93%) healed with a median of 9 months after rhBMP-2 application with no significant difference in the no-BMP group (33%) in time to union ( = 0.097) but a significantly higher union rate ( = 0.039). There was no effect of comorbidities, age, sex, soft tissue damage, or nicotine use on time to union, union rate, or secondary interventions.

Conclusion: Consistent with the literature, overall, significantly higher union rates with reduced time to union were achieved after rhBMP-2 application. Femoral and tibial non-unions in particular seem to profit from rhBMP-2 application.

Citing Articles

Open Reduction and Internal Fixation with Bone Morphogenetic Protein-2 for Correction of Nonunion Humeral Shaft Fracture with Pseudoarthrosis in the Geriatric Population: A Case Report.

Tapio R, Zhu K, Frolov D, Dolgov V, Schmitz M J Orthop Case Rep. 2024; 14(11):124-128.

PMID: 39524277 PMC: 11546032. DOI: 10.13107/jocr.2024.v14.i11.4938.

Healing of Humerus Non-union Fracture Using Recombinant Human Bone Morphogenetic Protein With Bone Graft Compared to Bone Graft Alone: A Systematic Review and Meta-Analysis.

Alhakbani M, Alqahtani A, AlTreef W, Aleisa A, Al Gahtani H, Alnasser M Cureus. 2024; 16(10):e71732.

PMID: 39429996 PMC: 11486634. DOI: 10.7759/cureus.71732.

Reconstruction of an Extensive Segmental Radial Shaft Bone Defect by Vascularized 3D-Printed Graft Cage.

Mommsen P, Marz V, Krezdorn N, Aktas G, Sehmisch S, Vogt P J Pers Med. 2024; 14(2).

PMID: 38392611 PMC: 10890561. DOI: 10.3390/jpm14020178.

Association of Fracture Location and Pattern With Nonunion or Malunion in Tibia Fractures Managed With Intramedullary Nailing: A Retrospective Study.

Alam M, Shirazi A, Alaradi H Cureus. 2023; 15(11):e49156.

PMID: 38130567 PMC: 10733781. DOI: 10.7759/cureus.49156.

Application of -Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures.

Kim Y, Lee J, Ha K, Kim S, Jung H, Kim G Bioengineering (Basel). 2023; 10(10).

PMID: 37892844 PMC: 10604299. DOI: 10.3390/bioengineering10101114.

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