Composite implant of native bovine bone morphogenetic protein (BMP), collagen carrier and biocoral in the treatment of resistant ulnar nonunions: report of five preliminary cases.
BACKGROUND
Bone morphogenetic protein (BMP) has been shown to induce bone formation and union in long bone defects and nonunions. There are, however, no previous reports of BMP being used for ulnar nonunions. We report on five cases of resistant ulnar nonunions treated with a composite implant consisting of a biocoral frame, collagen carrier, and bovine BMP.


METHODS
Four diaphyseal and one olecranon ulnar nonunions were treated using BMP/coral implant combined with internal fixation. Additional autografting was used in three cases. All of the cases were challenging in their own ways: Three of the patients had been operated on earlier for their nonunion without success, one had a 40 mm bone loss, and one had a 9-month-old untreated olecranon fracture. After excision of the sclerotic surfaces of the nonunion, the gap was filled with autograft and a composite implant containing BMP. Fixation was done with a compression plate in the diaphyseal nonunions and with a tension band in the olecranon nonunion.


RESULTS
Solid union was achieved in all five cases. No infections or other adverse effects were encountered.


CONCLUSIONS
These preliminary results suggest that BMP-containing implants might be a feasible alternative or superior to autografting in the treatment of resistant ulnar nonunions.
Kujala
Sauli
S
Department of Hand Surgery, Oulu University Hospital, PO Box 21, 90029 OYS, Finland. sauli.kujala@oulu.fi
Raatikainen
Timo
T
Ryhänen
Jorma
J
Kaarela
Outi
O
Jalovaara
Pekka
P
D000328:Adult; D000818:Animals; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use*; D002119:Calcium Carbonate / Q000627:therapeutic use*; D002417:Cattle; D003094:Collagen / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011859:Radiography; D020127:Recovery of Function; D018570:Risk Assessment; D014182:Transplantation, Autologous / Q000379:methods; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D000092464:Elbow Injuries
D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; C434403:calcium carbonate Biocoral; D003094:Collagen; D002119:Calcium Carbonate