Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions
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 li...
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MDPI AG
2021-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/19/4597 |
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| author | Thomas Fuchs Josef Stolberg-Stolberg Philipp A. Michel Patric Garcia Susanne Amler Dirk Wähnert Michael J. Raschke |
| author_facet | Thomas Fuchs Josef Stolberg-Stolberg Philipp A. Michel Patric Garcia Susanne Amler Dirk Wähnert Michael J. Raschke |
| author_sort | Thomas Fuchs |
| collection | DOAJ |
| description | 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 (<i>n</i> = 72) or standard care without BMP (<i>n</i> = 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 (<i>p</i> < 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%; <i>p</i> < 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%) (<i>p</i> = 0.26; <i>n</i> = 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; <i>p</i> = 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; <i>p</i> = 0.023) with significant differences in union rate with 85% and 44%, respectively (<i>p</i> = 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 (<i>p</i> = 0.097) but a significantly higher union rate (<i>p</i> = 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. |
| first_indexed | 2024-03-10T06:56:40Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T06:56:40Z |
| publishDate | 2021-10-01 |
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| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1d1995c7e9ec4c08aee4562e15a70f212023-11-22T16:21:49ZengMDPI AGJournal of Clinical Medicine2077-03832021-10-011019459710.3390/jcm10194597Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-UnionsThomas Fuchs0Josef Stolberg-Stolberg1Philipp A. Michel2Patric Garcia3Susanne Amler4Dirk Wähnert5Michael J. Raschke6Clinic for Orthopaedics, Trauma-, Hand- and Reconstructive Surgery, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249 Berlin, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, GermanyInstitute of Biostatistics and Clinical Research, University of Muenster, Schmeddingstrasse 56, 48149 Muenster, GermanyDepartment of Trauma and Orthopedic Surgery, Protestant Hospital of Bethel Foundation, Campus Bielefeld-Bethel, University Hospital OWL of Bielefeld University, Burgsteig 13, 33617 Bielefeld, GermanyDepartment of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, GermanyBackground: 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 (<i>n</i> = 72) or standard care without BMP (<i>n</i> = 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 (<i>p</i> < 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%; <i>p</i> < 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%) (<i>p</i> = 0.26; <i>n</i> = 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; <i>p</i> = 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; <i>p</i> = 0.023) with significant differences in union rate with 85% and 44%, respectively (<i>p</i> = 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 (<i>p</i> = 0.097) but a significantly higher union rate (<i>p</i> = 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.https://www.mdpi.com/2077-0383/10/19/4597bone morphogenetic proteinlong bone non-unionpseudarthrosisfracturebone healing |
| spellingShingle | Thomas Fuchs Josef Stolberg-Stolberg Philipp A. Michel Patric Garcia Susanne Amler Dirk Wähnert Michael J. Raschke Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions Journal of Clinical Medicine bone morphogenetic protein long bone non-union pseudarthrosis fracture bone healing |
| title | Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions |
| title_full | Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions |
| title_fullStr | Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions |
| title_full_unstemmed | Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions |
| title_short | Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions |
| title_sort | effect of bone morphogenetic protein 2 in the treatment of long bone non unions |
| topic | bone morphogenetic protein long bone non-union pseudarthrosis fracture bone healing |
| url | https://www.mdpi.com/2077-0383/10/19/4597 |
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