Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis

Abstract

We randomly assigned 17 patients with scaphoid non-union at the proximal pole to three treatment groups: (1) autologous iliac graft (n=6), (2) autologous iliac graft + osteogenic protein-1 (OP-1; n=6), and (3) allogenic iliac graft + OP-1 (n=5). Radiographic, scintigraphic, and clinical assessments were performed throughout the follow-up period of 24 months. OP-1 improved the performance of both autologous and allogenic bone implants and reduced radiographic healing time to 4 weeks compared with 9 weeks in group 1. Helical CT scans and scintigraphy showed that in OP-1-treated patients sclerotic bone was replaced by well-vascularised bone. The addition of OP-1 to allogenic bone implant equalised the clinical outcome with the autologous graft procedure. Consequently the harvesting of autologous graft can be avoided.Résumé Nous avons réparti 17 malades avec une pseudarthrose du pôle proximal du scaphoide en trois groupes aléatoires de traitement: (1) greffe autologue iliaque (n=6), (2) greffe autologue iliaque + protéine osteogenique-1 (OP-1; n=6), et (3) greffe allogène iliaque + OP-1 (n=5). L'estimation radiographique, scintigraphique et clinique a été exécutée pendant une période de suivi de 24 mois. L'OP-1 a amélioré la performance des autogreffes et des allogreffes osseuses et a réduit le temps curatif radiographique à 4 semaines, comparé à 9 semaines dans le groupe traité uniquement avec de l'os autologues. Chez les malades traités avec l'OP-1, la tomodensitométrie hélicoïdale et la scintigraphie ont montré que l'os scléreux était remplacé par de l'os bien vascularisé. L'addition d'OP-1 à la greffe allogène a égalisé le résultat clinique avec la procédure de greffe autologue et a permis de supprimer le temps de prise de greffe.

The Synergistic Effect of Autograft and BMP-7 in the Treatment of Atrophic Nonunions

“…They have been tested in various experimental animal nonunion models [32,39]. Since the FDA approval of BMP-7 for the treatment of recalcitrant tibial nonunions in 2001, its efficacy has been verified in a number of randomized trials [5,18,27] and large clinical series [12,15,23,26,33,38] with healing rates ranging from 81% to 92%.…”

BMP-6 exerts its osteoinductive effect through activation of IGF-I and EGF pathways

“…Bone morphogenetic proteins (BMP) are potent local factors that have been shown to have specific functions during organogenesis and embryogenesis, regulate the differentiation of mesenchymal progenitor cells, and promote bone and cartilage formation in bone and cartilage defects, fracture repair, and periodontal diseases [3,5,11,[15][16][17]. BMPs are members of the transforming growth factor-β (TGF-β) superfamily and were first identified by their ability to induce ectopic bone formation in vivo [11].…”

Efficacy of minimally invasive techniques for enhancement of fracture healing: evidence today

“…Injection of growth factors is based on the tremendous effect that these molecules exert to induce upregulation of bone healing [91]. Currently, a variety of molecules including BMP-2, BMP-7, platelet-derived growth factor, fibroblast derived growth factor and PTH have been used for the treatment of nonunions in experimental studies (animal models) [4,7,8,50,67,71,77,95,97,100,114]. The results have shown that the molecules are capable of upregulating the healing process, thus accelerating the fracture consolidation and mechanical properties [50, 71,77,89,95,100,114].…”

“…Autologous cancellous bone grafting (ABG) remains the gold standard biological method used to promote bone healing by stimulating the local micro-environment at the nonunion site [7,9,34,35,87,101]. However, its limited availability, as well as the donor site morbidity and complications such as chronic pain, neurovascular injury and infection have dictated the need for the development of alternative methods of biological stimulation [3,15,17,24,34,35,39,49,96,105,112].…”