Complications of recombinant human BMP-2 for treating complex tibial plateau fractures: a preliminary report.
Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fracture healing, few articles describe complications of BMP. In tibial plateau fractures, after elevating the cartilage en mass, a subchondral void may be created in these fractures. Structural support provided by bone void-filling agents can be augmented with osteoinduction achieved by BMP. We asked whether heterotopic bone formation would occur more frequently with BMP-2 when used in tibial plateau fractures and whether BMP-2 enhanced the ability to maintain surgically restored subchondral bone integrity. Heterotopic bone developed more frequently in patients receiving BMP (10 of 17) than in patients not receiving BMP (one of 23). Four patients receiving BMP and no patients not receiving BMP underwent removal of heterotopic bone. Maintenance of subchondral bone integrity was similar without and with the use of BMP. BMP is a potent osteoinductive agent; however, when used for an off-label indication in periarticular situations, complications such as heterotopic bone are common and increase reoperation rates.


METHODS
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Boraiah
Sreevathsa
S
Department of Orthopaedic Surgery, Hospital for Special Surgery, 520 East 70th Street, New York, NY 10021, USA. bsreevathsa@rediffmail.com
Paul
Omesh
O
Hawkes
David
D
Wickham
Matthew
M
Lorich
Dean G
DG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage / Q000009:adverse effects*; D016025:Bone Transplantation; D024042:Collagen Type I; D003131:Combined Modality Therapy; D004337:Drug Carriers; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery; D010865:Pilot Projects; D011859:Radiography; D011994:Recombinant Proteins / Q000009:adverse effects; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D024042:Collagen Type I; D004337:Drug Carriers; D011994:Recombinant Proteins
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