Healing of a Scaphoid Nonunion Using Human Bone Morphogenetic Protein
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Keywords:
Curettage
Bone grafting
Avascular Necrosis
Human bone
Bone morphogenetic proteins (BMPs) are a group of signalling molecules that belong to the transforming growth factor-β superfamily of proteins. Initially identified for their ability to induce bone formation, recent advances in the understanding of cellular and molecular mechanisms regarding BMPs have led to the use of the growth factor to accelerate bone healing. Recent clinical trials have demonstrated that BMPs, BMP-7 in particular, may present an alternative line of treatment other than the gold standard, autogenous bone grafting, in the treatment of fracture nonunion. We performed a literature search in September 2014 of PubMed and Embase using search terms, including "bone morphogenetic proteins", "BMP-7", "non-union", "fracture healing" and "cost-effectiveness", reviewing the efficacy, safety, and cost of treatment of nonunions with BMP-7. The authors further canvassed the reference lists of selected articles and used online search tools, such as Google Scholar. BMP-7 uses both the canonical and noncanonical signalling pathways. The treatment of fracture nonunion with recombinant human BMP-7 (rhBMP-7) has a comparable efficacy with that of autogenous bone grafting with an average union rate of 87% compared with 93% for bone grafting. Furthermore, fewer complications have been described with the use of rhBMP-7 compared with traditional bone grafting. We describe the signalling pathways that BMP-7 uses to exert its effect on bone. In nonunions, rhBMP-7 has been shown to have a similar efficacy to bone grafting with fewer complications.
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Abstract Background Bone morphogenetic proteins (BMPs) have strong bone induction properties and can promote healing of fractures and other defects. However, BMP treatment efficacy for long bone nonunion remains controversial. The aim of this meta-analysis was to synthetically evaluate the advantages and disadvantages of BMP plus bone grafting (observation group) versus autologous bone grafting (control group) for limb long bone nonunion. Methods PubMed, Embase, Web of Science, Cochrane Library, OVID, CNKI, Weipu Journal, Chinese Biomedical Literature, and WanFang were searched for randomized and non-randomized controlled trials published before November 2019. A meta-analysis of outcome indicators was performed using RevMan 5.3 and Stata 12.0. Results Five randomized and four non-randomized controlled trials involving 30–124 cases were included, with a total of 655 nonunion cases. There were no significant group differences in postoperative healing rate, infection, and secondary operation rates ( P > 0.05), but the study group demonstrated significantly shorter mean healing time (WMD = − 1.27, 95%CI − 1.67 to − 0.88, P < 0.00001), a greater frequency of excellent/good post-treatment limb function (RR = 1.18, 95%CI 1.01–1.39, P = 0.04), and lower intraoperative blood loss ( P < 0.05). Alternatively, the hospitalization cost was significantly higher in the study group ( P < 0.01). Conclusions Bone morphogenetic protein is a viable alternative to autologous bone grafting, with potential advantages of accelerated fracture healing and improved postoperative function.
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Severe periosteal and soft tissue disruption at the time of fracture may result in the formation of an atrophic nonunion. The purpose of this study was to evaluate whether the immediate application of recombinant human bone morphogenetic protein (BMP) to the fracture site could rescue the healing process in this nonunion model. In this atrophic nonunion model, we have demonstrated that the immediate application of BMP at the time of injury may rescue the fracture healing process and prevent the development of atrophic nonunion. Early application of BMP may obviate the need for additional surgical treatment, such as autogenous bone grafting, in situations where there is significant periosteal disruption.
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【Objective】To assess the clinical effectiveness of different surgical options for the treatment of non-infection nonunion of long limb fracture after initial fixation. 【Methods】From January 1996 to December 2006, 428 patients were treated with plate or locked intramedullary nailing fixation for long limb fracture, non-infection nonunion occurred 42 cases (9.81%). All of the 42 patients underwent revision operation. The methods were that exchanging for plate fixation or locked intramedullary nailing fixation combined with bone grafting in 33 cases, dynamization of the locking nail were performed in 9cases. 【Results】All of the patients were followed-up until the union occurred (average, 25 months). The healing percent of exchanging for plate fixation or locked intramedullary nailing fixation combined with bone grafting were 100%, average healing time were (13.5±6) months; and the healing percent of dynamization of the locking nail were 77.8%, average healing time were (15.5±6) months. 【Conclusion】 The better way to the non-infection nonunion of long limb fracture is reoperation with initial fixation combined with bone grafting, only dynamization of the locking nail were not enough and it may be nonunion later.
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Objective
To investigate the clinical efficacy of double steel plates combined with autogenous iliac bone grafting in treatment of aseptic nonunion after surgery for adult femoral shaft fracture.
Methods
A retrospective study was conducted to analyze the clinical data of 35 adult patients with aseptic nonunion after surgery for femoral shaft fracture admitted to the First Affiliated Hospital of Zhengzhou University from January 2017 to June 2018. There were 28 males and 7 females, aged 18 to 63 years. Twenty-one cases had been treated with plate fixation, and fourteen cases with intramedu-llary nail after fracture.Patients with intramedullary nail needed to remove the original internal fixation. While for patients with steel plate fixation, the original internal fixation could be removed or preserved in accordance with specific conditions. All patients were treated by double locking compression plates (LCP) combined with autogenous iliac bone grafting. The operation time, intraoperative blood loss, complications and fracture healing time were recorded.The outcomes were evaluated according to the hospital for special surgery (HSS) knee score.
Results
The operation time was 95 to 140 minutes, the intraoperative blood loss was 100 to 200 ml. There were 3 cases with the original internal fixation. All patients were followed up for 6-12 months. All patients healed after operation, and the time of fracture healing was 4-9 months. No breakage or loosening, internal fixation, incision infection, incision disunion, refracture occured during follow-up. The HSS knee score (86.77±8.41) and the excellent and good rate (91.43%)were improved, compared with pre-operative values (51.26±10.79, 5.71%).
Conclusions
Double steel plates combined with autogenous iliac bone grafting is a relatively ideal method to treat aseptic nonunion after surgery for adult femoral shaft fracture, which has high rate of fracture union and few complications.
Key words:
Femoral shaft fracture; Bone grafting; Locking compression plate, double steel plates; Aseptic nonunion
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