Skip to main content

Advertisement

Log in

Trattamento delle lesioni ossee traumatiche con le BMPs: revisione della letteratura

Treatment of traumatic bone injuries with BMPs: a review of the literature

  • Aggiornamenti
  • Published:
LO SCALPELLO-OTODI Educational

Abstract

The treatment of open fractures and fracture non-unions is a challenging situation for the orthopaedic surgeon. The use of bone morphogenetic proteins (BMPs) in the treatment of these injuries has been assessed by several authors. Indicated for the treatment of open tibial fractures treated with intramedullary fixation and for the treatment of tibial long-bone non-union, BMPs nowadays have been tested in other anatomical sites. Although the clinical efficacy in these cases has not been demonstrated definitely, the use of BMPs has also been considered on the basis of its high cost. This review summarises the evidence present in the literature on BMPs for the treatment of open fractures and non-unions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

Bibliografia

  1. Urist MR (1965) Bone: formation by autoinduction. Science 150:893–899

    Article  CAS  PubMed  Google Scholar 

  2. Reddi AH (2001) Bone morphogenetic proteins: from basic science to clinical applications. J Bone Joint Surg, Am 83:1–6

    Article  Google Scholar 

  3. Friedlaender GE, Perry CR, Cole JD et al. (2001) Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg, Am 83-A(Suppl 1(Pt2)):S151–S158

    Google Scholar 

  4. Govender S, Csimma C, Genant HK et al. (2002) Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg, Am 84(12):2123–2134

    Article  Google Scholar 

  5. Zimmermann G, Wagner C, Schmeckenbecher K et al. (2009) Treatment of tibial shaft non-unions: bone morphogenetic proteins versus autologous bone graft. Injury 40:50–53

    Article  Google Scholar 

  6. Arrington ED, Smith WJ, Chambers HG et al. (1996) Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res 329:300–309

    Article  Google Scholar 

  7. Argintar E, Edwards S, Delahay J (2011) Bone morphogenetic proteins in orthopaedic trauma surgery. Injury 42:730–734

    Article  PubMed  Google Scholar 

  8. Cook SD, Wolfe MW, Salkeld SL et al. (1995) Effect of recombinant human osteogenic protein-1 on healing of segmental defects in non-human primates. J Bone Joint Surg, Am 77(5):734–750

    Article  CAS  Google Scholar 

  9. Jones AL, Bucholz RW, Bosse MJ et al. (2006) Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects: a randomized, controlled trial. J Bone Joint Surg, Am 88(7):1431–1441

    Article  Google Scholar 

  10. Swiontkowski MF, Aro HT, Donell S et al. (2006) Recombinant human bone morphogenetic protein-2 in open tibial fractures: a subgroup analysis of data combined from two prospective randomized studies. J Bone Joint Surg, Am 88(6):1258–1265

    Article  Google Scholar 

  11. Schwartz ND, Hicks BM (2006) Segmental bone defects treated using recombinant human bone morphogenetic protein. J Orthop 3:e2

    Google Scholar 

  12. Kanakaris NK, Calori GM, Verdonk R et al. (2008) Application of BMP-7 to tibial non-unions: a 3-year multicenter experience. Injury 39(Suppl 2):83–90

    Article  Google Scholar 

  13. Ristiniemi J, Flinkkila T, Hyvonen P et al. (2007) RhBMP-7 accelerates the healing in distal tibial fractures treated by external fixation. J Bone Joint Surg, Br 89(2):265–272

    Article  CAS  Google Scholar 

  14. Kuklo TR, Groth AT, Anderson RC, Frisch HM (2008) Recombinant human bone morphogenetic protein-2 for grade III open segmental tibial fractures from combat injuries in Iraq. J Bone Joint Surg, Br 90(8):1068–1072

    Article  CAS  Google Scholar 

  15. Cook S (1999) Preclinical and clinical evaluation of osteogenic protein-1 (BMP-7) in bony sites. Orthopedics 22:669–671

    CAS  PubMed  Google Scholar 

  16. Bong MR, Capla EL, Egol KA et al. (2005) Osteogenic protein-1 (bone morphogenic protein-7) combined with various adjuncts in the treatment of humeral diaphyseal nonunions. Bull. Hosp. Joint Dis. 63:20–23

    Google Scholar 

  17. Dimitriou R, Dahabreh Z, Katsoulis E et al. (2005) Application of recombinant BMP-7 on persistent upper and lower limb non-unions. Injury 36(4):51–59

    Article  Google Scholar 

  18. Giannoudis PV (2005) Clinical applications of BMP-7: the UK perspective. Injury 36(Suppl 3):47–50

    Article  Google Scholar 

  19. Bilic R, Simic P, Jelic M et al. (2006) Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 30:128–134

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ronga M, Baldo F, Zappalà G, Cherubino P (2005) Recombinant human bone morphogenetic protein-7 for treatment of long bone non-union: an observational, retrospective, non-randomized study of 105 patients. Injury 37(Suppl 3):51–56

    Google Scholar 

  21. Giannoudis PV, Psarakis S, Kanakaris NK, Pape HC (2007) Biological enhancement of bone healing with Bone Morphogenetic Protein-7 at the clinical setting of pelvic girdle non-unions. Injury 38(Suppl 4):43–48

    Article  Google Scholar 

  22. Desmyter S (2008) The role of bone morphogenetic protein-7 (osteogenic protein-1) in the treatment of tibial fracture non-unions. An overview of the use in Belgium. Acta Orthop Belg 74:534–537

    PubMed  Google Scholar 

  23. Kanakaris NK, Lasanianos N, Calori GM et al. (2009) Application of bone morphogenetic proteins to femoral non-unions: a 4-year multicentre experience. Injury 40:54–61

    Article  Google Scholar 

  24. Calori GM, Tagliabue L, Gala L et al. (2008) Application of rhBMP-7 and platelet-rich plasma in the treatment of long bone non-unions. A prospective randomised clinical study on 120 patients. Injury 39:1391–1402

    Article  CAS  PubMed  Google Scholar 

  25. Kanakaris NK, Mallina R, Calori GM et al. (2009) Use of bone morphogenetic proteins in arthrodesis: clinical results. Injury 40:62–66

    Article  Google Scholar 

  26. Giannoudis PV, Kanakaris NK, Dimitriou R et al. (2009) The synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions. Clin Orthop Relat Res 467:3239–3248

    Article  PubMed  PubMed Central  Google Scholar 

  27. Crawford CH (2009) Atrophic nonunion of humeral diaphysis treated with locking plate and recombinant bone morphogenetic protein: nine cases. Am J Orthop (Belle Mead NJ) 38:567–570

    Google Scholar 

  28. Dohin B, Dahan-Oliel N, Fassier F, Hamdy R (2009) Enhancement of difficult nonunion in children with osteogenic protein-1 (OP-1): early experience. Clin Orthop Relat Res 467:3230–3238

    Article  PubMed  PubMed Central  Google Scholar 

  29. Desai PP, Bell AJ, Suk M (2010) Treatment of recalcitrant, multiply operated tibial nonunions with the RIA graft and rh-BMP2 using intramedullary nails. Injury 41(Suppl 2):69–71

    Article  Google Scholar 

  30. Tressler MA, Richards JE, Sofianos D et al. (2011) Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion. Orthopedics 34:877–884

    Article  Google Scholar 

  31. Papanna MC, Al-Hadithy N, Somanchi BV et al. (2012) The use of bone morphogenic protein-7 (OP-1) in the management of resistant non-unions in the upper and lower limb. Injury 43:1135–1140

    Article  CAS  PubMed  Google Scholar 

  32. Desai P, Hasan SM, Zambrana L et al. (2015) Bone mesenchymal stem cells with growth factors successfully treat nonunions and delayed unions. HSS J 11:104–111

    Article  PubMed  PubMed Central  Google Scholar 

  33. Brannan PS, Gaston RG, Loeffler BJ, Lewis DR (2016) Complications with the use of BMP-2 in scaphoid nonunion surgery. J Hand Surg Am 41:602–608

    Article  PubMed  Google Scholar 

  34. Ebraheim NA, Buchanan GS, Liu X et al. (2016) Treatment of distal femur nonunion following initial fixation with a lateral locking plate. Orthop Surg 8:323–330

    Article  PubMed  PubMed Central  Google Scholar 

  35. Von Rüden C, Morgenstern M, Hierholzer C et al. (2016) The missing effect of human recombinant Bone Morphogenetic Proteins BMP-2 and BMP-7 in surgical treatment of aseptic forearm nonunion. Injury 47:919–924

    Article  Google Scholar 

  36. Morison Z, Vicente M, Schemitsch EH, McKee MD (2016) The treatment of atrophic, recalcitrant long-bone nonunion in the upper extremity with human recombinant bone morphogenetic protein-7 (rhBMP-7) and plate fixation: a retrospective review. Injury 47:356–363

    Article  PubMed  Google Scholar 

  37. Singh R, Bleibleh S, Kanakaris NK, Giannoudis PV (2016) Upper limb non-unions treated with BMP-7: efficacy and clinical results. Injury 47:33–39

    Article  Google Scholar 

  38. Papanna MC, Saldanha KA, Kurian B et al. (2016) The use of recombinant morphogenic protein-2(rhBMP-2) in children undergoing revision surgery for persistent non-union. Strateg Trauma Limb Reconstr 11:53–58

    Article  Google Scholar 

  39. Hackl S, Hierholzer C, Friederichs J et al. (2017) Long-term outcome following additional rhBMP-7 application in revision surgery of aseptic humeral, femoral, and tibial shaft nonunion. BMC Musculoskelet Disord 18:1–10

    Article  Google Scholar 

  40. Haubruck P, Tanner MC, Vlachopoulos W et al. (2018) Comparison of the clinical effectiveness of bone morphogenic protein (BMP)-2 and -7 in the adjunct treatment of lower limb nonunions. Rev Chir Orthop Traumatol 104:832–833

    Google Scholar 

  41. Axelrad TW, Steen B, Lowenberg DW et al. (2008) Heterotopic ossification after the use of commercially available recombinant human bone morphogenetic proteins in four patients. J Bone Joint Surg, Br 90B:1617–1622

    Article  Google Scholar 

  42. Boraiah S, Paul O, Hawkes D, Wickham M (2009) Complications of recombinant human BMP-2 for treating complex tibial plateau fractures: a preliminary report. Clin Orthop Relat Res 467:3257–3262

    Article  PubMed  PubMed Central  Google Scholar 

  43. Ritting AW, Weber EW, Lee MC (2012) Exaggerated inflammatory response and bony resorption from BMP-2 use in a pediatric forearm nonunion. J Hand Surg Am 37:316–321

    Article  PubMed  Google Scholar 

  44. Wysocki RW, Cohen MS (2007) Ectopic ossification of the triceps muscle after application of bone morphogenetic protein-7 to the distal humerus for recalcitrant nonunion: a case report. J Hand Surg Am 32:647–650

    Article  PubMed  Google Scholar 

  45. Chen G, Yang JZ, Xu HM (2000) The application of NNB/BMP complex in the treatment of ununited-tibia fracture. Orthop J China 7:758–761

    Google Scholar 

  46. Perry CR, Cole D, Perry M (1997) Osteogenic protein (OP-1) vs autograft in the management of tibial non-unions [poster]. In: Orthopedic trauma association 1997 annual meeting, Louisville, KY pp 17–19.

    Google Scholar 

  47. Garrison K, Shemilt I, Donell S et al. (2008) Bone morphogenetic protein (BMP) for fracture healing in adults. Cochrane Database Syst Rev 6:CD006950

    Google Scholar 

  48. Shields LB, Raque GH, Glassman SD et al. (2006) Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion. Spine 31:542–547

    Article  PubMed  Google Scholar 

  49. Buttermann GR, Beaubien BP (2008) In vitro disc pressure profiles below scoliosis fusion constructs. Spine 33:2134–2142

    Article  PubMed  Google Scholar 

  50. Alt V, Heissel A (2006) Economic considerations for the use of recombinant human bone morphogenetic protein-2 in open tibial fractures in Europe: the German model. Curr Med Res Opin 22(Suppl 1):19–22

    Article  Google Scholar 

  51. Dahabreh Z, Calori GM, Kanakaris NK et al. (2009) A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop 33:1407–1414

    Article  CAS  PubMed  Google Scholar 

  52. Garrison KR, Donell S, Ryder J et al. (2007) Clinical effectiveness and cost-effectiveness of bone morphogenetic proteins in the non-healing of fractures and spinal fusion: a systematic review. Health Technol Assess 11:1–150

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mario Ronga.

Ethics declarations

Conflitto di interesse

Gli autori Jacopo Tamini, Biagio Tangredi, Michael Mazzacane, Roberto Marin, Federico Fazzari, Placido Stissi, Davide Pin, Giorgio Zappalà, Nicolò Castelnuovo, Ronga Mario dichiarano di non avere alcun conflitto di interesse.

Consenso informato e conformità agli standard etici

Tutte le procedure descritte nello studio e che hanno coinvolto esseri umani sono state attuate in conformità alle norme etiche stabilite dalla dichiarazione di Helsinki del 1975 e successive modifiche. Il consenso informato è stato ottenuto da tutti i pazienti inclusi nello studio.

Human and Animal Rights

L’articolo non contiene alcuno studio eseguito su esseri umani e su animali da parte degli autori.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamini, J., Tangredi, B., Mazzacane, M. et al. Trattamento delle lesioni ossee traumatiche con le BMPs: revisione della letteratura. LO SCALPELLO 33, 289–296 (2019). https://doi.org/10.1007/s11639-019-00334-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11639-019-00334-y

Navigation