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Randomized Controlled Trial
. 2006 Apr;30(2):128-34.
doi: 10.1007/s00264-005-0045-z. Epub 2006 Feb 28.

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

R Bilic  1 , P Simic, M Jelic, R Stern-Padovan, D Dodig, H Pompe van Meerdervoort, S Martinovic, D Ivankovic, M Pecina, S Vukicevic
Affiliations
Randomized Controlled Trial

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

R Bilic et al. Int Orthop. 2006 Apr.

Abstract
in English, French

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.

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.

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Figures

Fig. 1
Fig. 1
Radiograph of a patient (number 1) treated with autologous bone implant a before and b 8 weeks following operation. c CT scan 9 months following operation. d, e Radiograph of a patient (number 7) treated with autologous bone and OP-1 before (d) and 8 weeks following operation (e). f CT scan 9 months following operation. g, h Radiograph of a patient (number 13) treated with allogenic bone and OP-1 before (g) and 8 weeks following operation (h). i CT scan 9 months following operation
Fig. 2
Fig. 2
Late bone scintigraphy of a a patient (number 1) treated with autologous bone, b a patient (number 7) treated with autologous bone and OP-1, and c a patient (number 13) treated with allogenic bone and OP-1 24 months following operation. Higher uptake of 99mTc is present in surgically treated scaphoids (arrow), compared with opposite healthy hand (h). Increased vascular spaces in OP-1-treated patients (b, c) 24 months following operation indicate its permanent presence. 3D reconstruction of CT scans of d patient number 1, e patient number 7, and f patient number 13 24 months following operation. Minimal amounts of sclerotic bone (OS) are present in the proximal pole of patient number 7
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