title: Bone morphogenetic protein-2 for the treatment of congenital pseudarthrosis of the tibia or persistent tibial nonunion in children and adolescents: A retrospective study with a minimum 2-year follow-up.
abstract: There is a lack of studies reporting on rhBMP-2 application in pediatric orthopaedics, although few reports demonstrated promising results of the use of rhBMP-2 in children, especially for spine fusion and for the treatment of congenital pseudarthrosis of the tibia. The objectives of this study were (1) to examine clinical and radiographic healing after rhBMP-2 application for the treatment of congenital pseudarthrosis of the tibia (CPT) or persistent tibial nonunion in children and adolescents, and (2) to investigate the safety of rhBMP-2 use in these cases. Therefore we reviewed the medical records of ten patients with a mean age of 8.6 years (2.3-21) with CPT (n = 7) or persistent tibial nonunion for at least six months (n = 3) who had been treated with rhBMP-2. Nine of ten patients had union at final follow-up, after a mean of 72.9 months (25-127). In the CPT group, primary healing of the pseudarthrosis occurred in six of seven patients at a mean of 5.2 months (3-12). Repeat rhBMP-2 application was performed in three patients; two patients had one additional application each, and one patient had three additional applications. Complications that may be attributed to the use of rhBMP-2 were seen in two of fifteen applications, including a compartmemt syndrome and a hematoma. In this retrospective case series rhBMP-2 has been used successfully to treat CPT or persistent tibial nonunion in pediatric patients. However, prospective randomized controlled trials are warranted to investigate the long-term efficacy and safety of rhBMP-2 use in these cases.
authors.affiliation: Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Tim N
authors.initials: TN
authors.lastname: Hissnauer
authors.affiliation: Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Stiel
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Hamburg, Germany.|Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Babin
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Hamburg, Germany.|Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Rupprecht
authors.affiliation: Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Department of Trauma-, Hand-, and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Johannes M
authors.initials: JM
authors.lastname: Rueger
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Hamburg, Germany.|Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Stuecker
authors.affiliation: Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona, Hamburg, Germany. aspiro@uke.de.|Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. aspiro@uke.de.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Spiro
mesh_terms: D000293:Adolescent; D055396:Bone Morphogenetic Protein 2 / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011542:Pseudarthrosis / Q000151:congenital* / Q000628:therapy; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D013977:Tibia / Q000473:pathology; D013978:Tibial Fractures / Q000628:therapy*; D016212:Transforming Growth Factor beta / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: C525718:BMP2 protein, human; D055396:Bone Morphogenetic Protein 2; D011994:Recombinant Proteins; D016212:Transforming Growth Factor beta; C499469:recombinant human bone morphogenetic protein-2