The treatment of atrophic, recalcitrant long-bone nonunion in the upper extremity with human recombinant bone morphogenetic protein-7 (rhBMP-7) and plate fixation: A retrospective review
| Autor: | Michael D. McKee, Emil H. Schemitsch, Milena Vicente, Zachary Morison |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Upper extremity Bone Morphogenetic Protein 7 medicine.medical_treatment Long bone Nonunion Ulna Fracture Fixation Internal Fractures Bone Young Adult 03 medical and health sciences 0302 clinical medicine Bone plate Medicine and Health Sciences Humans Medicine Internal fixation Humerus 030212 general & internal medicine Aged Retrospective Studies General Environmental Science Aged 80 and over Fracture Healing 030222 orthopedics Bone Transplantation business.industry Bone Morphogenetic Protein Implant failure Middle Aged medicine.disease Clavicle Combined Modality Therapy Surgery medicine.anatomical_structure Fractures Ununited General Earth and Planetary Sciences Female business Bone Plates |
| Zdroj: | Bone and Joint Institute |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2015.11.035 |
| Popis: | © 2015 Elsevier Ltd. All rights reserved. Introduction Recombinant Human Bone Morphogenetic Protein-7 (rhBMP-7) has been shown to promote fracture healing in both clinical studies and basic science models, however, there is little information from large-scale studies of its use for human nonunion. The purpose of this study was to determine the safety and efficacy of rhBMP-7 in the treatment of atrophic human long-bone nonunions in the upper extremity. Patients and methods This was a single center, retrospective, longitudinal cohort study of patients treated with compression plating and the application of rhBMP-7 in isolation to a long-bone nonunion. Patients over sixteen years of age with an atrophic, aseptic nonunion of a humerus, radius, ulna or clavicle were eligible for inclusion. Results We identified seventy eligible patients who were treated with rhBMP-7 for a long-bone nonunion between July 1997 and April 2012. The mean age of the patients at the time of treatment with rhBMP-7 was 50.7 years (range, 20-92 years). Five patients were lost to follow-up prior to definitive clinical or radiographic union. During the one-year post-operative period fifty-six patients had achieved union and two patients developed a stable fibrous union after the index procedure. Two patients had early implant failure and five patients had persistent nonunion. Thus, the union rate following initial surgery was 89% (58/65) and four of the five nonunion patients went on to heal following revision open reduction and internal fixation. Conclusion We found that the application of rhBMP-7 for upper extremity nonunion was an effective method (89% union rate) of treating this challenging pathology. Additionally, if not initially successful, further reconstruction was not compromised by rhBMP-7 use. |
| Databáze: | OpenAIRE |
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