The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

  • Peter V. Giannoudis
  • Nikolaos K. Kanakaris
  • Rozalia Dimitriou
  • Ian Gill
  • Vinod Kolimarala
  • Richard J. Montgomery
Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors


Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this “graft expansion rationale.” There were 45 patients (32 male) with a median age of 43 years (range, 19–76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12–65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1–7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3–14 months) and 6 months (range, 4–16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3–6 months). The median visual analog scale pain score was 0.9 (range, 0–2.8; maximum 10), and the median functional score was 86 (range, 67–95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.


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Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  • Peter V. Giannoudis
    • 1
  • Nikolaos K. Kanakaris
    • 1
  • Rozalia Dimitriou
    • 1
  • Ian Gill
    • 2
  • Vinod Kolimarala
    • 2
  • Richard J. Montgomery
    • 2
  1. 1.Academic Department of Trauma and OrthopaedicsLeeds General InfirmaryLeedsUK
  2. 2.Department of Trauma and OrthopaedicsMiddlesbrough General HospitalMiddlesbroughUK

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