BONE MORPHOGENIC PROTEIN 7 : THE EARLY RESULTS FOLLOWING SALVAGE PROCEDURES FOR NON-UNION.

Abstract

Human recombinant bone morphogenic protein type 7 (BMP 7) is now available commercially for clinical use. In our trauma unit it has been used since September 2001 for patients with established intractable non-unions. We present the early results.

All consecutive patients receiving BMP 7 were reviewed regularly following treatment. All patients had established non-unions previously treated with a variety of methods. The patients were assessed for clinical evidence of fracture union (using stability and pain). Treatment episodes will be categorised as failures if there is no evidence of fracture union at 1 year following BMP 7 treatment. Plain x-rays were assessed by 2 independent radiologists and categorised into: Radiological evidence of fracture union; encouraging progression towards union; little evidence of fracture healing; atrophic non-union, hypertrophic non-union.

A total of 12 separate non-union sites have been treated in 10 patients (all male) to date. The mean age of the patients at follow up was 45 years. The series included 5 tibial non-unions, 3 femoral non-unions, 3 ulna non-unions with a mean of 3.3 treatments (range 1–7 treatments) and had endured symptoms, from initial injury to treatment with BMP 7, with a mean of 8.3 years (range 2 months-10.4 years). To date, the mean follow-up is 18 weeks (range 6–48 weeks).

Currently, 2 fractures have clinical & radiological union, 2 treatments have failed (implant failure and patient opted for amputation), 3 fractures are below 3months follow up, 5 fractures have a radiological classification as “encouraging” progression towards of union ( 4 with clinical union).

In a very difficult treatment group, we have encouraging early clinical results. Radiological evidence to compare to initial clinical results will be available shortly.