title: Recent developments in the use of bone morphogenetic protein in orthopaedic trauma surgery.
abstract: Delayed healing and non-union remain common problems in the treatment of open tibial shaft fractures. Additional surgical treatments may be required to facilitate healing. The efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2), as an adjunct to the standard of care, has been investigated in the BMP-2 Evaluation in Surgery for Tibial Trauma (BESTT) study. This prospective, randomised, multicentre, controlled study included 450 patients with acute, diaphyseal, open tibial fractures. A significant reduction in the risk of secondary intervention was observed in the 1.50 mg/mL rhBMP-2 group compared with the standard of care alone group (p = 0.0005). In a subgroup analysis of 131 patients with Gustilo-Anderson grade IIIA or IIIB open tibial fractures, using data combined from the BESTT study and a study conducted at 10 level I US trauma centres, a significant reduction in the incidence of secondary autologous bone graft procedures was observed with 1.50 mg/mL rhBMP-2 compared with the standard of care (p = 0.0005). The influence of fracture gap on the re-operation rate has also been examined in the BESTT study. In the 1.50 mg/mL rhBMP-2 group, patients with a 0 mm fracture gap had significantly less re-operations compared with those patients with a greater than 2 mm gap (p = 0.048).
authors.affiliation: Orthopaedic Centre, Ullevål University Hospital, N-0407 Oslo, Norway. lars.nordsletten@medisin.uio.no
authors.forename: L
authors.initials: L
authors.lastname: Nordsletten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013978:Tibial Fractures / Q000188:drug therapy* / Q000601:surgery; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000188:drug therapy / Q000601:surgery
chemical_list: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2