Recombinant Bone Morphogenetic Protein 7 (OP-1) has been available in the UK since 2001, but there has been little published data on its use in the upper limb. In our institution OP-1 has been used in the management of 23 upper limb patients between 2001–2005, including 10 humeral non-unions. We believe this represents one of the largest single-unit cohorts of humeral fractures treated with OP-1.

We reviewed the 10 humeral patients, who were all tertiary referrals with established non-unions. Two had been treated non-operatively before referral. The remaining eight had undergone a mean of 2.1 operations before OP-1 was used, with autologous bone grafting used in the majority of cases. Surgery occurred at a mean of 70.5 months following initial fracture. Seven patients underwent revision of the fracture fixation, and autologous bone graft was used with the OP-1 in 8 cases. Clinical union was established in 8 patients (80%) within a mean of 7.4 months. Radiological union was achieved in 8 patients (80%) within a mean of 9.1 months. No complications or adverse effects from the use of OP-1 were encountered.

Both cases which failed to unite had a definite history of deep infection prior to index surgery, despite initial treatment with a staged revision procedure before OP-1 use.

This study shows that OP-1 can be used successfully in the treatment of recalcitrant non-unions of the humerus following failure of traditional fracture management methods.

Purpose of Study: In the UK locoregional soft tissue cover is more traditionally within the remit of Plastic Surgeons. Currently only seven hospitals in the UK have Plastic Surgical units within trauma hospitals so that soft tissue cover often requires patient transfer between hospitals, with associated significant delays to surgery. This study set out to identify whether the current practice of soft tissue cover by an orthopaedic surgeon was justified.

Methods: 21 patients with a mean age of 44 years (range 7–87 years) had locoregional soft tissue cover surgery since 1996.

Results: Of 15 patients with open tibial fractures 3 (16%) went on to require an amputation at a mean of 10 months after injury (range 2–21 months). The mean delay between injury and soft tissue cover was 9 days (range 0–51 days). 11 cases went on to union at a mean of 7 months (range 4–11 months). 4 cases are yet to achieve union.

Of 22 flaps carried out there were only two flap failures. One was revised successfully with a gastrocnemius flap, whilst the other required a free latissimus dorsi flap which also failed requiring an above knee amputation.

Conclusions: These results are comparable to those from Plastic Surgical units. Locoregional soft tissue cover in the lower limb is therefore still safely within the remit of the Orthopaedic Surgeon. In the present economic climate there are strong financial incentives for avoiding transfer of trauma patients to other centres for such surgery.