title: Comparative study suggests that human bone morphogenetic proteins have no influence on the outcome of operative treatment of aseptic clavicle non-unions.
abstract: The purpose of this study was to evaluate the clinical and radiological outcome following compression plate fixation in combination with autologous bone grafting, with and without additional application of recombinant human bone morphogenetic protein (rhBMP) for treatment of aseptic clavicle non-union.
  
  
  
  Between April 2004 and April 2015, 82 patients were treated for clavicle fracture and had developed aseptic clavicle non-union. Seventy-three out of 82 patients were available for follow-up at least one year after revision surgery; among them, 27 women and 46 men, with a median age of 49 (range, 19-86) years. Forty-five patients received compression plate osteosynthesis with autologous bone grafting, and 28 patients obtained compression plate fixation with autologous bone grafting and additional application of rhBMP-2 (3/28 patients) or rhBMP-7 (25/28 patients).
  
  
  
  Seventy out of 73 non-unions (96 %) healed within 12 months after revision surgery. Functional outcome according to the DASH Outcome Measure (with rhBMP, 33.16 ± 1.17 points; without rhBMP, 30.58 ± 2.12 points [mean ± SEM]; p = 0.81), non-union healing (p = 0.86), time interval between revision surgery and bone healing (p = 0.37), as well as post-operative complications, did not demonstrate relevant differences between the treatment groups and were not age-dependent.
  
  
  
  Functional and radiological results demonstrate that successful healing of aseptic clavicle non-union is dependent on radical resection of non-union tissue, restoration of length of the shoulder girdle and application of stable locking-plate osteosynthesis in combination with autologous bone grafting, but not dependent on application of additional rhBMP.
authors: Department of Trauma Surgery, Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany. christian.vonrueden@bgu-murnau.de.|Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria. christian.vonrueden@bgu-murnau.de.
authors: Christian
authors: C
authors: von Rüden
authors: Department of Traumatology, University Hospital Basel, Basel, Switzerland.
authors: Mario
authors: M
authors: Morgenstern
authors: Department of Trauma Surgery, Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
authors: Jan
authors: J
authors: Friederichs
authors: Institute of Biomechanics, Paracelsus Medical University, Salzburg, Austria.
authors: Peter
authors: P
authors: Augat
authors: Department of Trauma Surgery, Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
authors: Simon
authors: S
authors: Hackl
authors: Department of Trauma Surgery, Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
authors: Alexander
authors: A
authors: Woltmann
authors: Department of Trauma Surgery, Trauma Centre Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
authors: Volker
authors: V
authors: Bühren
authors: Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors: Christian
authors: C
authors: Hierholzer
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055396:Bone Morphogenetic Protein 2 / Q000008:administration & dosage*; D055419:Bone Morphogenetic Protein 7 / Q000008:administration & dosage*; D001860:Bone Plates; D016025:Bone Transplantation; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D012086:Reoperation; D012189:Retrospective Studies; D016212:Transforming Growth Factor beta / Q000008:administration & dosage*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C525819:BMP7 protein, human; D055396:Bone Morphogenetic Protein 2; D055419:Bone Morphogenetic Protein 7; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2
keywords: Bone graft; Bone morphogenetic protein; Clavicle; DASH Outcome Measure; Locking compression plate; Non-union; rhBMP-2; rhBMP-7