Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) for the Treatment of Nonunion of the Femur in Children and Adolescents: A Retrospective Analysis.

Tim N Hissnauer,Johannes M Rueger,Karsten Ridderbusch,Alexander S Spiro,Kornelia Babin,Martin Rupprecht,Ralf Stuecker,Norbert Stiel

doi:10.1155/2017/3046842

Tim N Hissnauer, Johannes M Rueger + Show 6 more

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https://doi.org/10.1155/2017/3046842

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Abstract

Background. The aim of this study was to examine clinical and radiographic healing after rhBMP-2 application in children and adolescents presenting with nonunion of the femur and to investigate the safety of rhBMP-2 use in these cases. Materials and Methods. We reviewed the medical records of five patients with a mean age of 11 years (5.4 to 16.2) with nonunion of the femur who were treated with rhBMP-2 and internal fixation using a locking plate at a single institution. Particular attention was paid to identify all adverse events that may be due to rhBMP-2 use. Results. Union occurred in four of five patients at a mean of 12.1 months (7.9 to 18.9). The locking plates were removed after a mean of 16 months (11 to 23). One patient had nonunion due to deep infection. After a mean follow-up of 62.5 months (17 to 100), union was still evident in all four patients and they were fully weight-bearing without pain. Discussion. In this retrospective study, rhBMP-2 combined with a locking plate has been used successfully to treat children and adolescents with nonunion of the femur in four of five cases. One major complication was thought to be possibly related to its use.

Highlights

The treatment of nonunion of long bones often requires a multimodal therapy including numerous operations
We reviewed the medical records and radiographs of all patients with nonunion of the femur who had been treated with rhBMP-2 and internal fixation using a locking plate at the Pediatric Orthopaedic Department of Children’s Hospital Hamburg-Altona, Hamburg, Germany (Table 1)
The off-label use of rhBMP-2 and rhBMP-7 in orthopedic surgery has considerably increased in the last years [20]

Summary

Introduction

The treatment of nonunion of long bones often requires a multimodal therapy including numerous operations. Surgical methods comprise resection of the nonvascular tissue at the nonunion site, external or internal fixation, and the use of autogenous bone graft or bone graft substitutes [1,2,3,4] Due to their important role in bone formation and fracture healing by being involved in the cascade of cellular events of tissue formation and regeneration, bone morphogenetic proteins (BMPs) have gained increased attention in recent years [5,6,7,8,9,10,11]. Application of rhBMP-2 for the treatment of nonunion of the femur was reported in only one previous study (2 cases), focusing on complications associated with BMP use at different sites in 81 children [15]. In this retrospective study, rhBMP-2 combined with a locking plate has been used successfully to treat children and adolescents with nonunion of the femur in four of five cases. One major complication was thought to be possibly related to its use

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