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

2021 ◽  
Vol 10 (19) ◽  
pp. 4597
Author(s):  
Thomas Fuchs ◽  
Josef Stolberg-Stolberg ◽  
Philipp A. Michel ◽  
Patric Garcia ◽  
Susanne Amler ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Bone Healing ◽  
Treatment Effectiveness ◽  
Patient Characteristics ◽  
Bone Morphogenetic Protein 2 ◽  
Long Bone ◽  
X Rays ◽  
Union Rate ◽  
Morphogenetic Protein ◽  
Significant Difference

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 (n = 72) or standard care without BMP (n = 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 (p < 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%; p < 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%) (p = 0.26; n = 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; p = 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; p = 0.023) with significant differences in union rate with 85% and 44%, respectively (p = 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 (p = 0.097) but a significantly higher union rate (p = 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.

“Bone Morphogenic Protein augmentation for long bone healing” response to “Clinical need for bone morphogenetic protein”

2017 ◽  
Vol 41 (11) ◽  
pp. 2417-2419 ◽  
Author(s):  
Gopal Shankar Krishnakumar ◽  
Alice Roffi ◽  
Davide Reale ◽  
Elizaveta Kon ◽  
Giuseppe Filardo
Keyword(s):  
Bone Morphogenetic Protein ◽  
Bone Healing ◽  
Bone Morphogenic Protein ◽  
Long Bone ◽  
Healing Response ◽  
Morphogenetic Protein

scholarly journals Oxidized alginate hydrogels for bone morphogenetic protein-2 delivery in long bone defects

2014 ◽  
Vol 10 (10) ◽  
pp. 4390-4399 ◽  
Author(s):  
Lauren B. Priddy ◽  
Ovijit Chaudhuri ◽  
Hazel Y. Stevens ◽  
Laxminarayanan Krishnan ◽  
Brent A. Uhrig ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Bone Defects ◽  
Bone Morphogenetic Protein 2 ◽  
Long Bone ◽  
Morphogenetic Protein ◽  
Alginate Hydrogels

scholarly journals Bone morphogenetic protein-2-impregnated biomimetic scaffolds successfully induce bone healing in a marginal mandibular defect

2013 ◽  
Vol 123 (5) ◽  
pp. 1149-1155 ◽  
Author(s):  
Adam S. DeConde ◽  
Douglas Sidell ◽  
Min Lee ◽  
Olga Bezouglaia ◽  
Kyle Low ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Bone Healing ◽  
Bone Morphogenetic Protein 2 ◽  
Morphogenetic Protein ◽  
Biomimetic Scaffolds ◽  
Mandibular Defect

scholarly journals Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2

2017 ◽  
Vol 30 (02) ◽  
pp. 153-159 ◽  
Author(s):  
Anna Massie ◽  
Mark Fuller ◽  
Frank Verstraete ◽  
Boaz Arzi ◽  
Amy Kapatkin
Keyword(s):  
Bone Morphogenetic Protein ◽  
Bone Fractures ◽  
Perioperative Complications ◽  
Human Bone ◽  
Bone Morphogenetic Protein 2 ◽  
Long Bone ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Recombinant Human Bone

SummaryObjectives: To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of non union long-bone fractures in dogs.Methods: A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases.Results: Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7–20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up.Clinical significance: Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

scholarly journals Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

2016 ◽  
Vol 24 (4) ◽  
pp. 556-564 ◽  
Author(s):  
Kern H. Guppy ◽  
Jessica Harris ◽  
Jason Chen ◽  
Elizabeth W. Paxton ◽  
Julie Alvarez ◽  
...  
Keyword(s):  
Bone Morphogenetic Protein ◽  
Patient Characteristics ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Morphogenetic Protein ◽  
Significant Difference ◽  
Spinal Fusions ◽  
Reoperation Rates

OBJECTIVE Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups. METHODS Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.

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