title: Clinical application of BMP 7 in long bone non-unions.
abstract: BACKGROUND
  Non-unions of long bone fractures are a therapeutic and economic problem of increasing frequency. Aside from conservative treatment options such as ultrasound, impulse waves, and casts, the basic surgical options are autogenous cancellous bone grafting, rod dynamization, reamed nailing, plate fixation, and bone transport techniques. If these methods fail to work, there is a need for alternative treatment options.
  
  
  METHODS
  Since May 2001, treatment with recombinant human bone morphogenic protein 7 (BMP 7 or osteogenic protein 1) in combination with a type-one collagen carrier has been the subject of increasing interest. BMP 7 induces the formation of new bone by stem cell differentiation, thereby initiating the reaction cascade of osteogenesis. Non-unions over 9 months and unsuccessful bone grafting constitute the indication for this treatment.
  
  
  RESULTS
  We report our experience with 54 patients who had atrophic non-union of long bone fractures. Between May 2002 and May 2006, 57 units of BMP 7 were used. The localization of the non-unions included 21 in the femur, 26 in the tibia, 3 in the humerus and 7 in the forearm. In 36 cases, BMP 7 was used in combination with osteosynthesis revision and bone grafting; in 9 additional patients, BMP 7 was used with bone grafting alone. In 12 patients, BMP 7 was applied as a single procedure without any bone grafting or any change in osteosynthesis.
  
  
  CONCLUSIONS
  There were no perioperative or postoperative complications. Follow-up was obtained for a minimum of 6 months. 47 of the 57 (82%) implantations were successful, with bony healing confirmed by clinical and radiological evaluation. In summary, our results support BMP 7 as an additional innovative therapy for long bone non-unions.
authors.affiliation: BG Trauma Center Ludwigshafen, Unfallchirurgische Klinik, University of Heidelberg, Ludwig, Guttmann, Str. 13, 67071, Ludwigshafen, Germany. moghaddam@bgu-ludwigshafen.de
authors.forename: Arash
authors.initials: A
authors.lastname: Moghaddam
authors.forename: Charlotte
authors.initials: C
authors.lastname: Elleser
authors.forename: Bahram
authors.initials: B
authors.lastname: Biglari
authors.forename: Andreas
authors.initials: A
authors.lastname: Wentzensen
authors.forename: Gerald
authors.initials: G
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000368:Aged; D055419:Bone Morphogenetic Protein 7 / Q000627:therapeutic use*; D016025:Bone Transplantation; D005260:Female; D017102:Fracture Healing / Q000187:drug effects; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D055419:Bone Morphogenetic Protein 7