title: Combined treatment of congenital pseudarthrosis of the tibia, including recombinant human bone morphogenetic protein-2: a case series.
abstract: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) for the treatment of congenital pseudarthrosis of the tibia has been investigated in only one previous study, with promising results. The aim of this study was to determine whether rhBMP-2 might improve the outcome of this disorder. We reviewed the medical records of five patients with a mean age of 7.4 years (2.3 to 21) with congenital pseudarthrosis of the tibia who had been treated with rhBMP-2 and intramedullary rodding. Ilizarov external fixation was also used in four of these patients. Radiological union of the pseudarthrosis was evident in all of them at a mean of 3.5 months (3.2 to 4) post-operatively. The Ilizarov device was removed after a mean of 4.2 months (3.0 to 5.3). These results indicate that treatment of congenital pseudarthrosis of the tibia using rhBMP-2 in combination with intramedullary stabilisation and Ilizarov external fixation may improve the initial rate of union and reduce the time to union. Further studies with more patients and longer follow-up are necessary to determine whether this surgial procedure may significantly enhance the outcome of congenital pseudarthrosis of the tibia, considering the refracture rate (two of five patients) in this small case series.
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Children's Hospital, Hamburg, Germany. aspiro@uke.uni-hamburg.de
authors.forename: A S
authors.initials: AS
authors.lastname: Spiro
authors.forename: K
authors.initials: K
authors.lastname: Babin
authors.forename: S
authors.initials: S
authors.lastname: Lipovac
authors.forename: P
authors.initials: P
authors.lastname: Stenger
authors.forename: K
authors.initials: K
authors.lastname: Mladenov
authors.forename: M
authors.initials: M
authors.lastname: Rupprecht
authors.forename: J M
authors.initials: JM
authors.lastname: Rueger
authors.forename: R
authors.initials: R
authors.lastname: Stuecker
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology; D055396:Bone Morphogenetic Protein 2; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing / Q000187:drug effects; D006801:Humans; D018889:Ilizarov Technique; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D011542:Pseudarthrosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
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