Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions?
The purpose of this study was to evaluate the efficacy and safety of a combination of recombinant human bone morphogenetic protein 7 (rhBMP-7) and resorbable calcium phosphate bone substitute (rCPBS) as a salvage solution for recalcitrant tibial fracture nonunions. Twenty consecutive patients, 16 male and four female, with a mean age of 46.8±15.7 years (21-78) and a mean body mass index (BMI) of 24.2±5.3kgm(-2) (21.5-28.5), suffering from 20 recalcitrant tibial fracture nonunions were included. The mean number of operations performed prior to the procedure was 3.3, with homolateral iliac crest bone grafts being used for all of the patients. All patients were treated with a procedure including debridement and decortications of the bone ends, nonunion fixation with a locking plate, and filling of the bony defect with a combined graft of rhBMP-7 (as osteoinductor) with an rCPBS (as scaffold). The mean follow-up was 14±2.7 months. Both clinical and radiological union occurred in 18 cases, within a mean time of 4.7±3.2 months. A recurrence of deep infection was diagnosed for one of the non-consolidated patients. No specific complication of rCPBS or rhBMP-7 was encountered. This study supports the view that the application of rCPBS combined with rhBMP-7, without any bone grafting, is safe and efficient in the treatment of recalcitrant bone union.
Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France. Electronic address: ollivier.mt@gmail.com.
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Ollivier
Department of Hand Surgery and Limb Reconstruction, Aix-Marseille University, Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France.
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Gay
Department of Hand Surgery and Limb Reconstruction, Aix-Marseille University, Timone Hospital, 264 Rue Saint Pierre, 13385 Marseille, France.
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Cerlier
Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
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Lunebourg
Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
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Argenson
Department of Orthopedic Surgery, Institute of Movement, UMR 7287: Aix-Marseille University, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
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Parratte
D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D055419:Bone Morphogenetic Protein 7 / Q000627:therapeutic use; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use*; D016025:Bone Transplantation; D002130:Calcium Phosphates / Q000627:therapeutic use*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000473:pathology / Q000628:therapy*; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy; D013978:Tibial Fractures / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome
C525819:BMP7 protein, human; D001672:Biocompatible Materials; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D002130:Calcium Phosphates
BMP; Bone nonunion; Bone substitute; Recalcitrant; Tibia