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Segmental Bone Defects Treated Using Recombinant Human Bone Morphogenetic Protein

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Author(s): Niles D. Schwartz

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 3;
Issue: 2;
Date: 2006;
Original page

Keywords: segmental bone defect | recombinant BMP

ABSTRACT
Introduction: Current treatment of segmental bone defects includes amputation, autograft, bone transport, free vascularized fibula, and acute shortening. All have recognized significant complications and morbidity. Recombinant human bone morphogenetic proteins have been used successfully in lumbar fusion and acute open tibia fractures. The purpose of this study was to evaluate the union potential of recombinant human bone morphogenetic protein-2 (rhBMP-2) implanted on an absorbable collagen sponge (ACS) in human segmental bone defects. Methods: We performed a retrospective analysis using rhBMP-2/ACS with bone graft substitutes (calcium sulfate or calcium phosphate) in treating 19 segmental bone defects in 18 patients. Etiology included acute trauma, post-trauma infection, or nonunion. There were 11 males and 7 females. There were 9 femur fractures, 6 tibial fractures, 2 clavicle fractures, 1 humerus fracture, and 1 ulnar fracture. Ten defects were 100% circumferential, while 9 were partial defects. Defect length averaged 4.75 cm, ranging from 1.5 to 8.0 cm. Open fractures occurred in 14 patients. Failure was determined as need for further surgical intervention or nonunion. A fracture was noted as healed by clinical use without pain and radiographic consolidation. Results: Bony union occurred in 16 of 19 bone defects, with a union rate of 84%. Average time to union was 8.4 months (range 3.5 to 13.5 months). Failure was noted in 3 patients. Two of these patients were treated early on in the study with calcium sulfate in association with rhBMP-2/ACS and had premature resorption of the graft. The third failed patient had fixation failure at 6 weeks due to non-compliance. No infections were reported. No clinical reactions from the rhBMP-2 were reported. Discussion and Conclusion: rhBMP-2 has the capability to heal critically sized bone defects in a variety of patients, with a success rate of 84% in our study. This can be done without the morbidity associated with auto-graft or many of the complications of other treatment. Treatment can also occur in a timely fashion given the severity of injury in some cases.
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