Zusammenfassung
Die verzögerte oder fehlende Heilung von Schaftfrakturen langer Röhrenknochen stellt bis heute eine große chirurgische Herausforderung dar. Insbesondere bei prädisponierenden Faktoren für die Pseudarthrosebildung, wie z. B. Adipositas permagna, Diabetes mellitus, lokale Zirkulationsstörung oder Hormonmangel, zeigen die etablierten Behandlungsmöglichkeiten der autologen Spongiosaplastik oder der Wechsel des Osteosyntheseverfahrens oftmals nur unzureichende Ergebnisse. Im Folgenden wird die erfolgreiche kombinierte Anwendung des Knochenwachstumsfaktors BMP-7 mit körpereigenem Knochen zur Therapie einer therapieresistenten Unterschenkelpseudarthrose beschrieben. Bei vorbestehenden multiplen Risikofaktoren konnte die Unterschenkelfraktur nach 2-maligem Materialversagen und erfolgloser autologer Spongiosaplastik zur Ausheilung gebracht werden. Der Patient ist 10 Monate nach erfolgter adjuvanter BMP-7-Implantation völlig beschwerdefrei und selbstständig mobil.
Abstract
Delayed union or non-union of long bone shaft fractures still presents a surgical challenge. Especially if there is a predisposition for pseudarthrosis such as adiposity, diabetes mellitus, local disruption of blood supply or lack of hormones, the established procedures of autologous cancellous bone grafting or plate fixation with compression often lead to insufficient results. In the following article the successful use of bone morphogenetic protein BMP-7 [recombinant human osteogenetic protein-1 (rhOP-1)], combined with autologous bone grafting for therapy of a therapy-resistant tibial non-union is described. In a patient with multiple risk factors the tibial fracture was completely cured after two attempts of osteosynthesis and autologous bone grafting had failed. The patient achieved self-mobility with full weight bearing and absence of pain 10 months after adjuvant implantation of BMP-7.
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Siebenlist, S., Kraus, T., Burghardt, R. et al. Therapieresistente Unterschenkelpseudarthrose. Unfallchirurg 113, 59–64 (2010). https://doi.org/10.1007/s00113-009-1673-3
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DOI: https://doi.org/10.1007/s00113-009-1673-3