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. 2023 Jan;18(1):80-88.
doi: 10.1177/1558944721990805. Epub 2021 Mar 31.

Bone Morphogenic Protein for Upper Extremity Fractures: A Systematic Review

Alexis B Sandler  1 , John P Scanaliato  2 , Sorana Raiciulescu  3 , Leon Nesti  3 , John C Dunn  2
Affiliations

Bone Morphogenic Protein for Upper Extremity Fractures: A Systematic Review

Alexis B Sandler et al. Hand (N Y). 2023 Jan.

Abstract

Background: This review discusses success, time to healing, and complications of bone morphogenic proteins (BMPs) 7 and 2 in treating upper extremity nonunions.

Methods: Systematic review identified 26 of 479 studies that met inclusion criteria. Publications described application of BMPs to acute and chronic upper extremity delayed unions/nonunions. Unions, complications, patient demographics, and fracture/healing patterns were pooled and analyzed.

Results: Nonunions treated with BMP-7 (n=302) involved the humerus (64%), forearm (22%), clavicle (11%), and hand/wrist (3%), with prior surgical correction attempted in 84%. Nonunions treated with BMP-2 (n=96) involved the humerus (58%), hand/wrist (27%), forearm (14%), and clavicle (1%), with prior surgical correction attempted in all. Most nonunions (80%) were present for over 12 months before BMP application. Union rates of BMP-7 varied according to site: hand/wrist (95%), humerus (74%), forearm (29%), and clavicle (6.2%) nonunions achieved union as defined by study authors in 232 days (confidence interval=96-369, Q<0.001) on average. While not significant across studies, BMP-2 union rates were 71% of hand/wrist and 75% of humerus nonunions. Comparison of the BMPs demonstrates different proportions of success in humerus and hand/wrist fractures (P<.001) but not forearm fractures (P<.77) and longer time to radiographic union with BMP-7 (P<.011).

Conclusions: Most hand/wrist and humerus nonunions treated with BMP-7 and BMP-2 achieved union, with significant similarity among BMP-7 studies not observed in BMP-2 studies. Nonunions treated with BMP-7 have longer healing times yet similar complication rates compared with BMP-2. Overall, BMPs are an effective adjunct to fracture healing with acceptable complication profile.

Keywords: allograft; basic science; diagnosis; distal radius; forearm; fracture/dislocation; hand; humerus; wrist.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Note. BMP = bone morphogenic protein.
Figure 2.
Figure 2.
Nonunion chronicity distribution. Note. BMP = bone morphogenic protein.
See this image and copyright information in PMC

References

    1. Calori GM, Colombo M, Bucci M, et al.. Clinical effectiveness of Osigraft in long-bones non-unions. Injury. 2015;46:S55-S64. - PubMed
    1. Conway JD, Shabtai L, Bauernschub A, et al.. BMP-7 versus BMP-2 for the treatment of long bone nonunion. Orthopedics. 2014;37:e1049-e1057. - PubMed
    1. Giannoudis PV, Kanakaris NK, Dimitriou R, et al.. The synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions. Clin Orthop Relat Res. 2009;467:3239-3248. - PMC - PubMed
    1. Papanna MC, Al-Hadithy N, Somanchi BV, et al.. The use of bone morphogenic protein-7 (OP-1) in the management of resistant non-unions in the upper and lower limb. Injury. 2012;43:1135-1140. - PubMed
    1. Murena L, Canton G, Vulcano E, et al.. Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7, and mesenchymal stem cells. Orthopedics. 2014;37:e201-e206. - PubMed

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