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

  • Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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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Authors and Affiliations

  1. Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, Leeds, LS1 3EX, UK

    Peter V. Giannoudis MD, EEC (Ortho), Nikolaos K. Kanakaris MD & Rozalia Dimitriou MSc, MD

  2. Department of Trauma and Orthopaedics, Middlesbrough General Hospital, Middlesbrough, UK

    Ian Gill MB, BS, Vinod Kolimarala MB, BS & Richard J. Montgomery FRCS

Authors
  1. Peter V. Giannoudis MD, EEC (Ortho)
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  2. Nikolaos K. Kanakaris MD
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  3. Rozalia Dimitriou MSc, MD
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  4. Ian Gill MB, BS
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  5. Vinod Kolimarala MB, BS
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  6. Richard J. Montgomery FRCS
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Correspondence to Peter V. Giannoudis MD, EEC (Ortho).

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Leeds General Infirmary and Middlesbrough General Hospital.

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Giannoudis, P.V., Kanakaris, N.K., Dimitriou, R. et al. The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions. Clin Orthop Relat Res 467, 3239–3248 (2009). https://doi.org/10.1007/s11999-009-0846-2

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  • DOI: https://doi.org/10.1007/s11999-009-0846-2

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