Treatment of non-unions of long bones in the last years has seen the new chance of BMP augmentation. We had already treated difficult and recalcitrant non-unions with Concentrated Bone Marrow alone or associated with Platelet Derived Growth Factor (PDGF). The availability of the Bone Morphogenetic Protein 7 (BMP 7, OP 1) allowed us to compare the results of both treatments. We have now 40 cases from February 2001 to March 2006. Seven non unions affected the humerus, 30 non unions affected the lower limb, 18 cases the femur, 14 cases the tibia and one an attempted subtalar arthrodesis. The average age was 30 years (16-65). In five cases we used the bone marrow with a percutaneous technique with a 60% healing success. The two failures of this technique were in the same patient. In 35 cases we used open surgery and added bone graft plus PDGF and Bone Marrow in 16 cases, OP 1 alone in 16 cases and Bone Marrow plus OP1 in the last 3 cases. The healing rate of all groups was similar (87% vs 87% vs 100%). The higher result of the last treatment (Bone Marrow + OP 1 ± PDGF) was only on three patients and should be further evaluated. The patients treated with OP 1 experienced a greater number of previous surgeries (>3), still the BMP-7 proved to be effective in these cases. We suggest that surgeons should take into account the use of BMP-7 that proved to be effective in selected , previously failed patients for non unions and that adding Concentrated Bone Marrow might improve these already impressive results.
Treatment of non-unions of long bones with bone marrow alone or combined with platelet rich plasma or recombinant bone morphogenetic protein 7 (OP 1). An ongoing observational study
CAPANNA, RODOLFO
2006-01-01
Abstract
Treatment of non-unions of long bones in the last years has seen the new chance of BMP augmentation. We had already treated difficult and recalcitrant non-unions with Concentrated Bone Marrow alone or associated with Platelet Derived Growth Factor (PDGF). The availability of the Bone Morphogenetic Protein 7 (BMP 7, OP 1) allowed us to compare the results of both treatments. We have now 40 cases from February 2001 to March 2006. Seven non unions affected the humerus, 30 non unions affected the lower limb, 18 cases the femur, 14 cases the tibia and one an attempted subtalar arthrodesis. The average age was 30 years (16-65). In five cases we used the bone marrow with a percutaneous technique with a 60% healing success. The two failures of this technique were in the same patient. In 35 cases we used open surgery and added bone graft plus PDGF and Bone Marrow in 16 cases, OP 1 alone in 16 cases and Bone Marrow plus OP1 in the last 3 cases. The healing rate of all groups was similar (87% vs 87% vs 100%). The higher result of the last treatment (Bone Marrow + OP 1 ± PDGF) was only on three patients and should be further evaluated. The patients treated with OP 1 experienced a greater number of previous surgeries (>3), still the BMP-7 proved to be effective in these cases. We suggest that surgeons should take into account the use of BMP-7 that proved to be effective in selected , previously failed patients for non unions and that adding Concentrated Bone Marrow might improve these already impressive results.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
