title: Bone morphogenetic protein augmentation grafting of resistant femoral nonunions. A preliminary report.
abstract: Twelve patients with intractable nonunions of the femoral diaphyseal or metaphyseal-diaphyseal shaft were successfully treated by a combination of internal fixation and implants of human bone morphogenetic protein (h-BMP). There was an average of 4.3 surgical procedures per patient attempting union prior to h-BMP implantation. Union was obtained in 11 of 12 patients and in one patient with a repeat stabilization and implantation of h-BMP. Four patients received autogeneic cancellous bone graft and four patients received allogeneic bone grafts. The BMP implant was prepared in the form of an aggregate of h-BMP and bone matrix water-insoluble noncollagenous proteins (h-BMP/iNCP). Fifty to 100 mg of h-BMP/iNCP was either implanted in the fracture gap in ultra thin gelatin capsules, or incorporated in a strip of polylactic/polyglycolic acid copolymer (PLA/PGA) and placed as an onlay across the fracture gap. The average time to union was 4.7 months. Further clinical investigations are planned as a series of matched cases with and without BMP augmentation in order to distinguish h-BMP effects from new or improved methods of fracture fixation combined with autogeneic cancellous bone grafts.
authors.affiliation: Division of Orthopaedic Surgery, University of California, Los Angeles 90024.
authors.forename: E E
authors.initials: EE
authors.lastname: Johnson
authors.forename: M R
authors.initials: MR
authors.lastname: Urist
authors.forename: G A
authors.initials: GA
authors.lastname: Finerman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019485:Bone Morphogenetic Proteins; D016025:Bone Transplantation; D003131:Combined Modality Therapy; D004341:Drug Evaluation; D004343:Drug Implants; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011506:Proteins / Q000627:therapeutic use*; D011859:Radiography; D014945:Wound Healing
chemical_list: D019485:Bone Morphogenetic Proteins; D004343:Drug Implants; D011506:Proteins