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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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Autores principales: Fuchs, Thomas, Stolberg-Stolberg, Josef, Michel, Philipp A., Garcia, Patric, Amler, Susanne, Wähnert, Dirk, Raschke, Michael J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509770/
https://www.ncbi.nlm.nih.gov/pubmed/34640615
http://dx.doi.org/10.3390/jcm10194597
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author Fuchs, Thomas
Stolberg-Stolberg, Josef
Michel, Philipp A.
Garcia, Patric
Amler, Susanne
Wähnert, Dirk
Raschke, Michael J.
author_facet Fuchs, Thomas
Stolberg-Stolberg, Josef
Michel, Philipp A.
Garcia, Patric
Amler, Susanne
Wähnert, Dirk
Raschke, Michael J.
author_sort Fuchs, Thomas
collection PubMed
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 (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.
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spelling pubmed-85097702021-10-13 Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions Fuchs, Thomas Stolberg-Stolberg, Josef Michel, Philipp A. Garcia, Patric Amler, Susanne Wähnert, Dirk Raschke, Michael J. J Clin Med Article 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. MDPI 2021-10-06 /pmc/articles/PMC8509770/ /pubmed/34640615 http://dx.doi.org/10.3390/jcm10194597 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fuchs, Thomas
Stolberg-Stolberg, Josef
Michel, Philipp A.
Garcia, Patric
Amler, Susanne
Wähnert, Dirk
Raschke, Michael J.
Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8509770/
https://www.ncbi.nlm.nih.gov/pubmed/34640615
http://dx.doi.org/10.3390/jcm10194597
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