Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion
Abstract Background Surgical revision concepts for the treatment of aseptic humeral, femoral, and tibial diaphyseal nonunion were evaluated. It was analyzed if the range of time to bone healing was shorter, and if clinical and radiological long-term outcome was better following application of additi...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2017-08-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12891-017-1704-0 |
| _version_ | 1818081901735313408 |
|---|---|
| author | Simon Hackl Christian Hierholzer Jan Friederichs Alexander Woltmann Volker Bühren Christian von Rüden |
| author_facet | Simon Hackl Christian Hierholzer Jan Friederichs Alexander Woltmann Volker Bühren Christian von Rüden |
| author_sort | Simon Hackl |
| collection | DOAJ |
| description | Abstract Background Surgical revision concepts for the treatment of aseptic humeral, femoral, and tibial diaphyseal nonunion were evaluated. It was analyzed if the range of time to bone healing was shorter, and if clinical and radiological long-term outcome was better following application of additional recombinant human Bone Morphogenetic Protein-7 (rhBMP-7) compared to no additional rhBMP-7 use. Methods In a retrospective comparative study between 06/2006 and 05/2013, 112 patients diagnosed with aseptic diaphyseal humerus (22 patients), femur (41 patients), and tibia (49 patients) nonunion were treated using internal fixation and bone graft augmentation. For additional stimulation of bone healing, growth factor rhBMP-7 was locally administered in 62 out of 112 patients. Follow-up studies including clinical and radiological assessment were performed at regular intervals as well as after at least one year following nonunion surgery. Results One hundred and two out of 112 (humerus: 19, femur: 37, tibia: 47) nonunion healed within 12 months after revision surgery without any significant differences between the cohort groups. According to the DASH outcome measure for the humerus (p = 0.679), LEFS for the femur (p = 0.251) and the tibia (p = 0.946) as well as to the SF-12 for all entities, no significant differences between the treatment groups were found. Conclusions Aseptic diaphyseal nonunion in humerus, femur, and tibia healed irrespectively of additional rhBMP-7 application. Moreover, the results of this study suggest that successful nonunion healing can be linked to precise surgical concepts using radical removal of nonunion tissue, stable fixation and restoration of axis, length and torsion, rather than to the additional use of signaling proteins. Trial registration This clinical trial was conducted according to ICMJE guidelines as well as to the approval of the National Medical Board (Ethics Committee of the Bavarian State Chamber of Physicians; TRN: 2016-104) and has been retrospectively registered with the German Clinical Trails Register (TRN: DRKS00012652 ). |
| first_indexed | 2024-12-10T19:13:34Z |
| format | Article |
| id | doaj.art-a51d649d04bc4b4e930c41f6553c66c0 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-12-10T19:13:34Z |
| publishDate | 2017-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-a51d649d04bc4b4e930c41f6553c66c02022-12-22T01:36:39ZengBMCBMC Musculoskeletal Disorders1471-24742017-08-0118111010.1186/s12891-017-1704-0Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunionSimon Hackl0Christian Hierholzer1Jan Friederichs2Alexander Woltmann3Volker Bühren4Christian von Rüden5Department of Trauma Surgery, BG Trauma Center MurnauDepartment of Trauma Surgery, University Hospital ZurichDepartment of Trauma Surgery, BG Trauma Center MurnauDepartment of Trauma Surgery, BG Trauma Center MurnauDepartment of Trauma Surgery, BG Trauma Center MurnauDepartment of Trauma Surgery, BG Trauma Center MurnauAbstract Background Surgical revision concepts for the treatment of aseptic humeral, femoral, and tibial diaphyseal nonunion were evaluated. It was analyzed if the range of time to bone healing was shorter, and if clinical and radiological long-term outcome was better following application of additional recombinant human Bone Morphogenetic Protein-7 (rhBMP-7) compared to no additional rhBMP-7 use. Methods In a retrospective comparative study between 06/2006 and 05/2013, 112 patients diagnosed with aseptic diaphyseal humerus (22 patients), femur (41 patients), and tibia (49 patients) nonunion were treated using internal fixation and bone graft augmentation. For additional stimulation of bone healing, growth factor rhBMP-7 was locally administered in 62 out of 112 patients. Follow-up studies including clinical and radiological assessment were performed at regular intervals as well as after at least one year following nonunion surgery. Results One hundred and two out of 112 (humerus: 19, femur: 37, tibia: 47) nonunion healed within 12 months after revision surgery without any significant differences between the cohort groups. According to the DASH outcome measure for the humerus (p = 0.679), LEFS for the femur (p = 0.251) and the tibia (p = 0.946) as well as to the SF-12 for all entities, no significant differences between the treatment groups were found. Conclusions Aseptic diaphyseal nonunion in humerus, femur, and tibia healed irrespectively of additional rhBMP-7 application. Moreover, the results of this study suggest that successful nonunion healing can be linked to precise surgical concepts using radical removal of nonunion tissue, stable fixation and restoration of axis, length and torsion, rather than to the additional use of signaling proteins. Trial registration This clinical trial was conducted according to ICMJE guidelines as well as to the approval of the National Medical Board (Ethics Committee of the Bavarian State Chamber of Physicians; TRN: 2016-104) and has been retrospectively registered with the German Clinical Trails Register (TRN: DRKS00012652 ).http://link.springer.com/article/10.1186/s12891-017-1704-0NonunionHumerusFemurTibiaRecombinant human bone morphogenetic protein-7 (rhBMP-7)Bone graft |
| spellingShingle | Simon Hackl Christian Hierholzer Jan Friederichs Alexander Woltmann Volker Bühren Christian von Rüden Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion BMC Musculoskeletal Disorders Nonunion Humerus Femur Tibia Recombinant human bone morphogenetic protein-7 (rhBMP-7) Bone graft |
| title | Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion |
| title_full | Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion |
| title_fullStr | Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion |
| title_full_unstemmed | Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion |
| title_short | Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion |
| title_sort | long term outcome following additional rhbmp 7 application in revision surgery of aseptic humeral femoral and tibial shaft nonunion |
| topic | Nonunion Humerus Femur Tibia Recombinant human bone morphogenetic protein-7 (rhBMP-7) Bone graft |
| url | http://link.springer.com/article/10.1186/s12891-017-1704-0 |
| work_keys_str_mv | AT simonhackl longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion AT christianhierholzer longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion AT janfriederichs longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion AT alexanderwoltmann longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion AT volkerbuhren longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion AT christianvonruden longtermoutcomefollowingadditionalrhbmp7applicationinrevisionsurgeryofaseptichumeralfemoralandtibialshaftnonunion |