Recombinant Human BMP-2 for the Treatment of Open Tibial Fractures
Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment...
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Published in | Orthopedics (Thorofare, N.J.) Vol. 35; no. 6; pp. e847 - e854 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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SLACK INCORPORATED
01.06.2012
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Abstract | Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included.
The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively;
P
<.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively;
P
<.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively;
P
=.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case.
Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures. |
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AbstractList | Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included.
The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively;
P
<.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively;
P
<.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively;
P
=.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case.
Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures. Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included.The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; P<.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively; P<.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively; P=.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case.Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures. Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included. The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; P<.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively; P<.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively; P=.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case. Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures. Recombinant human bone morphogenetic protein-2 (rhBMP-2) improves healing of open tibial fractures treated with intramedullary nail fixation. However, routine use has not occurred. The purposes of the current study were to provide a systematic review of the literature using rhBMP-2 in the treatment of acute open tibial fractures treated with intramedullary nail fixation and to provide a meta-analysis of the randomized, controlled trials. Multiple databases, reference lists of relative articles, and main orthopedic journals were searched. The basic information and major results were compared. Four studies with a total of 609 patients were included. The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; The secondary intervention rate in the standard-of-care (SOC) group was significantly higher than in the rhBMP-2 combined with absorbable collagen sponge (rhBMP-2/ACS) group (27.1% vs 17.5%, respectively; P <.01). The treatment failure rate in the SOC group was significantly higher (34.3% vs. 21.4%, respectively; P <.01). No significant differences were found in infection rate, hardware failure rate, fracture healing rate at 20 weeks, and postoperative pain level. For patients treated with reamed intramedullary nail fixation, only the treatment failure rate in the SOC group was significantly higher (21.5% vs 14.2%, respectively; P =.02); no other significant difference was observed. Adding rhBMP-2 to the treatment of Gustilo-Anderson grade IIIA and B open tibial fractures led to net savings of approximately $6000 per case. Recombinant human bone morphogenetic protein-2 added to intramedullary nail fixation of open tibial fractures could reduce the frequency of secondary interventions and total health care costs. For reamed patients, adding rhBMP-2 reduced treatment failure. This analysis supports the clinical efficacy of rhBMP-2/ACS for the treatment of these severe fractures. |
Author | Xianhua Cai Jifeng Huang Ximing Liu Shijun Wei Qing Wang Feng Xu |
Author_xml | – sequence: 1 givenname: Shijun surname: Wei fullname: Wei, Shijun organization: Department of Orthopaedic Surgery, Wuhan General Hospital of Guangzhou Military Command, Wuhan, China – sequence: 2 givenname: Xianhua surname: Cai fullname: Cai, Xianhua – sequence: 3 givenname: Jifeng surname: Huang fullname: Huang, Jifeng – sequence: 4 givenname: Feng surname: Xu fullname: Xu, Feng – sequence: 5 givenname: Ximing surname: Liu fullname: Liu, Ximing – sequence: 6 givenname: Qing surname: Wang fullname: Wang, Qing |
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Cites_doi | 10.2106/00004623-198769060-00002 10.1097/00005131-199412000-00008 10.1097/00005131-199502000-00011 10.2106/00004623-199703000-00003 10.2106/JBJS.G.01694 10.1097/00007632-200002010-00020 10.1097/00005373-198409000-00003 10.2106/JBJS.E.00499 10.1302/0301-620X.53B4.696 10.2106/00004623-200212000-00001 10.1302/0301-620X.83B1.10986 10.1097/01.BRS.0000048469.45035.B9 10.1007/s00264-004-0567-9 10.1016/j.jval.2010.10.034 10.1016/j.injury.2007.02.052 10.1097/00003086-199706000-00008 10.1080/17453670510041808 10.2106/JBJS.I.01763 10.1016/0197-2456(95)00134-4 10.1007/s00113-006-1079-4 10.1016/S8756-3282(02)00740-8 10.2106/00004623-198668060-00009 10.1016/j.injury.2009.02.007 |
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References_xml | – start-page: 98 issue: 230 year: 1988 ident: e_1_3_1_6_2 article-title: Severe open tibial fractures. Results treating 202 injuries with external fixation publication-title: Clin Orthop Rel Res contributor: fullname: Edwards CC – start-page: 778 issue: 43 year: 1994 ident: e_1_3_1_25_2 article-title: The management of fractures with soft-tissue disruptions publication-title: Instr Course Lect contributor: fullname: Sanders R – ident: e_1_3_1_8_2 doi: 10.2106/00004623-198769060-00002 – ident: e_1_3_1_9_2 doi: 10.1097/00005131-199412000-00008 – ident: e_1_3_1_7_2 doi: 10.1097/00005131-199502000-00011 – volume: 17 start-page: 11 issue: 1 year: 1997 ident: e_1_3_1_14_2 article-title: A feasibility study evaluating rhBMP-2/absorbable collagen sponge for maxillary sinus floor augmentation publication-title: Int J Periodontics Restorative Dent contributor: fullname: Boyne PJ – start-page: 34 issue: 105 year: 1974 ident: e_1_3_1_26_2 article-title: Tibial blood supply in relation to fracture healing publication-title: Clin Orthop Rel Res contributor: fullname: Rhinlander FW – start-page: 89 issue: 212 year: 1986 ident: e_1_3_1_24_2 article-title: Interlocking nailing of complex fractures of the femur and tibia publication-title: Clin Orthop Rel Res contributor: fullname: Klemm KW – ident: e_1_3_1_28_2 doi: 10.2106/00004623-199703000-00003 – ident: e_1_3_1_20_2 doi: 10.2106/JBJS.G.01694 – ident: e_1_3_1_13_2 doi: 10.1097/00007632-200002010-00020 – ident: e_1_3_1_11_2 doi: 10.1097/00005373-198409000-00003 – ident: e_1_3_1_10_2 doi: 10.2106/JBJS.E.00499 – ident: e_1_3_1_23_2 doi: 10.1302/0301-620X.53B4.696 – start-page: 144 issue: 105 year: 1974 ident: e_1_3_1_2_2 article-title: Closed and open management of tibial fractures publication-title: Clin Orthop Relat Res contributor: fullname: Nicoll EA – ident: e_1_3_1_18_2 doi: 10.2106/00004623-200212000-00001 – ident: e_1_3_1_12_2 doi: 10.1302/0301-620X.83B1.10986 – start-page: 26 issue: 212 year: 1986 ident: e_1_3_1_22_2 article-title: The role of intramedullary fixation in open fractures publication-title: Clin Orthop Rel Res contributor: fullname: Chapman MW – ident: e_1_3_1_15_2 doi: 10.1097/01.BRS.0000048469.45035.B9 – ident: e_1_3_1_29_2 doi: 10.1007/s00264-004-0567-9 – ident: e_1_3_1_31_2 doi: 10.1016/j.jval.2010.10.034 – ident: e_1_3_1_27_2 doi: 10.1016/j.injury.2007.02.052 – ident: e_1_3_1_5_2 doi: 10.1097/00003086-199706000-00008 – ident: e_1_3_1_30_2 doi: 10.1080/17453670510041808 – ident: e_1_3_1_17_2 doi: 10.2106/JBJS.I.01763 – ident: e_1_3_1_19_2 doi: 10.1016/0197-2456(95)00134-4 – ident: e_1_3_1_4_2 doi: 10.1007/s00264-004-0567-9 – ident: e_1_3_1_32_2 doi: 10.1007/s00113-006-1079-4 – ident: e_1_3_1_16_2 doi: 10.1016/S8756-3282(02)00740-8 – ident: e_1_3_1_21_2 doi: 10.2106/00004623-198668060-00009 – ident: e_1_3_1_3_2 doi: 10.1016/j.injury.2009.02.007 |
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SubjectTerms | Adult Bone Morphogenetic Protein 2 - genetics Bone Morphogenetic Protein 2 - therapeutic use Bone surgery Combined Modality Therapy - statistics & numerical data Failure Female Fracture Fixation, Intramedullary - statistics & numerical data Fracture Healing - drug effects Fractures Fractures, Open - epidemiology Fractures, Open - therapy Humans Infections Male Meta-analysis Patients Prevalence Recombinant Proteins - therapeutic use Statistical analysis Systematic review Tibial Fractures - epidemiology Tibial Fractures - therapy Treatment Outcome |
Title | Recombinant Human BMP-2 for the Treatment of Open Tibial Fractures |
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