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Treatment of congenital pseudarthrosis of the tibia with recombinant human bone morphogenetic protein-7 (rhBMP-7). A report of five cases

Cited 51 time in Web of Science Cited 0 time in Scopus
Authors
Lee, Francis Young-In; Sinicropi, Stefano M.; Lee, Fred Suin; Vitale, Michael G.; Roye, David P. Jr; Choi, In Ho
Issue Date
2006
Publisher
Journal of Bone and Joint Surgery, Inc.
Citation
J Bone Joint Surg Am. 2006;88:627-33
Keywords
Bone Morphogenetic Protein 7Bone Morphogenetic Proteins/*therapeutic useFracture Fixation, InternalFracture HealingProspective StudiesPseudarthrosis/*congenital/radiography/*therapyRecombinant Proteins/*therapeutic useTibial Fractures/*congenital/radiography/*therapyTransforming Growth Factor beta/*therapeutic useTreatment Outcome
Abstract
Congenital pseudarthrosis of the tibia is one of the most
frustrating conditions encountered in pediatric orthopaedics
because of the difficulty in achieving healing.
Numerous treatment options have been explored with varying
degrees of success1-19. Although some reports have demonstrated
successful healing7,9,19, it is very difficult to restore the
normal structural and functional integrity of the bone such as
that which occurs after treatment of other types of fractures in
children. Advances in molecular biology have provided a better
understanding of the mechanisms of fracture-healing as well
as possible new solutions for the problem, including the use
of bone morphogenetic protein (BMP)20-24. In a controlled,
prospective, randomized study of 124 tibial nonunions (in
122 adult patients) treated with insertion of an intramedullary
rod and recombinant human (rh) BMP-7, no significant
difference (p = 0.939) was noted between the BMP group
and the group that received an intramedullary rod and autogenous
iliac crest bone grafts20. In a prospective, randomized,
controlled, single-blind study of 450 patients with an
open tibial fracture, patients who were treated with rhBMP-
2 (1.50 mg/mL) had significantly (p = 0.005) superior results
compared with patients who were treated with intramedullary
nail fixation and routine soft-tissue management as dictated
by the injury21. These two large clinical series suggest
that BMPs may be a good alternative to autogenous iliaccrest
bone-grafting.
Bone morphogenetic proteins have shown promising
results in experimental animal models, and their clinical efficacy
has been shown in the treatment of adult tibial nonunions
and in spinal fusion20-24. They have not been tested in
children because of uncertainty as to the effect on adjacent
physes and because of concern about unexpected reactions.
The use of BMP to treat congenital pseudarthrosis of the tibia
is a logical approach because the results from both animal
studies and human trials have suggested that BMP is efficacious
in bone-healing. This prospective study was undertaken
to determine the clinical efficacy and safety of the use of
rhBMP-7 for the treatment of congenital pseudarthrosis of the
tibia in skeletally immature patients and to compare the results
with those of previously published studies in which autogenous
iliac-crest bone grafts have been used in conjunction
with various fixation methods.
ISSN
0021-9355 (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16510831

http://hdl.handle.net/10371/10911
DOI
https://doi.org/10.2106/JBJS.D.02201
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College of Medicine/School of Medicine (의과대학/대학원)Orthopedic Surgery (정형외과학전공)Journal Papers (저널논문_정형외과학전공)
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