title: The treatment of atrophic, recalcitrant long-bone nonunion in the upper extremity with human recombinant bone morphogenetic protein-7 (rhBMP-7) and plate fixation: A retrospective review.
abstract: BACKGROUND
  Recombinant Human Bone Morphogenetic Protein-7 (rhBMP-7) has been shown to promote fracture healing in both clinical studies and basic science models, however, there is little information from large-scale studies of its use for human nonunion. The purpose of this study was to determine the safety and efficacy of rhBMP-7 in the treatment of atrophic human long-bone nonunions in the upper extremity.
  
  
  METHODS
  This was a single center, retrospective, longitudinal cohort study of patients treated with compression plating and the application of rhBMP-7 in isolation to a long-bone nonunion. Patients over sixteen years of age with an atrophic, aseptic nonunion of a humerus, radius, ulna or clavicle were eligible for inclusion.
  
  
  RESULTS
  We identified seventy eligible patients who were treated with rhBMP-7 for a long-bone nonunion between July 1997 and April 2012. The mean age of the patients at the time of treatment with rhBMP-7 was 50.7 years (range, 20-92 years). Five patients were lost to follow-up prior to definitive clinical or radiographic union. During the one-year post-operative period fifty-six patients had achieved union and two patients developed a stable fibrous union after the index procedure. Two patients had early implant failure and five patients had persistent nonunion. Thus, the union rate following initial surgery was 89% (58/65) and four of the five nonunion patients went on to heal following revision open reduction and internal fixation.
  
  
  CONCLUSIONS
  We found that the application of rhBMP-7 for upper extremity nonunion was an effective method (89% union rate) of treating this challenging pathology. Additionally, if not initially successful, further reconstruction was not compromised by rhBMP-7 use.
authors.affiliation: Investigation conducted at St Michael's Hospital, Toronto, Canada.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Morison
authors.affiliation: Investigation conducted at St Michael's Hospital, Toronto, Canada.
authors.forename: Milena
authors.initials: M
authors.lastname: Vicente
authors.affiliation: Investigation conducted at St Michael's Hospital, Toronto, Canada.
authors.forename: Emil H
authors.initials: EH
authors.lastname: Schemitsch
authors.affiliation: Investigation conducted at St Michael's Hospital, Toronto, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055419:Bone Morphogenetic Protein 7 / Q000627:therapeutic use*; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D002968:Clavicle; D003131:Combined Modality Therapy; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing; D050723:Fractures, Bone / Q000503:physiopathology / Q000628:therapy*; D005599:Fractures, Ununited / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D006811:Humerus; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014457:Ulna; D055815:Young Adult
chemical_list: C525819:BMP7 protein, human; D055419:Bone Morphogenetic Protein 7
keywords: Bone Morphogenetic Protein; Nonunion; Upper extremity