Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) for the Treatment of Nonunion of the Femur in Children and Adolescents: A Retrospective Analysis

Abstract

Background. The aim of this study was to examine clinical and radiographic healing after rhBMP-2 application in children and adolescents presenting with nonunion of the femur and to investigate the safety of rhBMP-2 use in these cases. Materials and Methods. We reviewed the medical records of five patients with a mean age of 11 years (5.4 to 16.2) with nonunion of the femur who were treated with rhBMP-2 and internal fixation using a locking plate at a single institution. Particular attention was paid to identify all adverse events that may be due to rhBMP-2 use. Results. Union occurred in four of five patients at a mean of 12.1 months (7.9 to 18.9). The locking plates were removed after a mean of 16 months (11 to 23). One patient had nonunion due to deep infection. After a mean follow-up of 62.5 months (17 to 100), union was still evident in all four patients and they were fully weight-bearing without pain. Discussion. In this retrospective study, rhBMP-2 combined with a locking plate has been used successfully to treat children and adolescents with nonunion of the femur in four of five cases. One major complication was thought to be possibly related to its use.

Figure 1

((a) and (b)) Anteroposterior preoperative (a) and postoperative (b) radiographs of a 10-year-old boy with infantile cerebral palsy with coxa antetorta who underwent femoral derotation osteotomy with use of a locking plate on both sides. (c) Anteroposterior radiograph of the same patient demonstrates persistent femoral nonunion with screw breakage of two femoral neck screws on the right side. (d) Anteroposterior radiograph two days after surgical revision with removal of the locking plate, resection of the femoral nonunion, application of rhBMP-2, and insertion of a new locking plate. (e) Anteroposterior radiograph 7.9 months after surgical intervention with use of rhBMP-2 demonstrating complete radiological healing which was still evident at the most recent follow-up, 60 months after rhBMP-2, was applied.