title: Treatment of a double nonunion of the femur by rhBMP-2.
abstract: A 49-year-old patient sustained an ipsilateral fracture of the lateral femoral neck and distal femoral shaft, which were treated with a long intramedullary nail with a hip screw component. Both fractures did not heal, and both nonunion sites were revised by reosteosynthesis with a dynamic hip screw for the femoral neck and a locked intramedullary nail for the shaft region combined with autogenous bone grafting at both sites. At 14 months from injury and after 2 operations, both nonunions persisted. At a third surgery, 1 kit of recombinant human bone morphogenetic protein-2 (rhBMP-2) on an absorbable collagen sponge was applied to each site, without any modification of the osteosynthesis or additional bone grafting. The lateral femoral neck and the femoral shaft consolidated 24 and 30 weeks, respectively, after the rhBMP-2 application, and the patient resumed his work as industrial worker after 7 months after his last surgery. We believe this is the first study to report the successful use of 2 kits of rhBMP-2 in a double nonunion of the femur.
authors.affiliation: Department of Trauma Surgery, University Hospital Giessen-Marburg, Site Giessen, Giessen, Germany. volker.alt@chiru.med.uni-giessen.de
authors.forename: Volker
authors.initials: V
authors.lastname: Alt
authors.forename: Christof
authors.initials: C
authors.lastname: Meyer
authors.forename: Horst Detlef
authors.initials: HD
authors.lastname: Litzlbauer
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schnettler
mesh_terms: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D004343:Drug Implants; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D005599:Fractures, Ununited / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016212:Transforming Growth Factor beta / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins; D004343:Drug Implants; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2