Document Detail


Recombinant bone morphogenetic protein-2 (rhBMP-2) in high-risk ankle and hindfoot fusions.
MedLine Citation:
PMID:  19589304     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The purpose of this study was to evaluate the effect of rhBMP-2 on bone healing in patients who undergo high-risk ankle & hindfoot fusions.
MATERIALS & METHODS: Patients who underwent high-risk, elective ankle and hindfoot fusions treated with rhBMP-2 augmentation were reviewed for clinical outcomes and complications. A total of 112 fusion sites (69 patients) were reviewed for analysis. The mean age of the patients was 52 years (range, 21 to 84 years). There were 37 males (53%) and 32 females (47%). Forty-four patients (64%) were smokers and 13 patients (19%) were diabetic. A history of high-energy trauma was present in 47 (68%) patients and avascular necrosis of the talus was present in 22 patients (32%). Forty-five patients (65%) had multiple risk-factors. The exclusion criteria were peripheral vascular disease, infection, and patients who were not available for the usual follow-up protocol. Internal and/or external fixation was utilized for ankle and hindfoot fusions. Bone graft was used only for patients who had defects or malalignment. Postoperatively, nonweightbearing radiographs were taken every 2 to 4 weeks (3 views per site). When plain radiographic union was evident, a confirmatory CT scan was obtained.
RESULTS: Overall, 108 fusion sites went on to union (96% union rate) at a mean time of 11 weeks (as assessed by a CT scan) [ankle joint at 10 weeks; subtalar joint at 12.3 weeks; talonavicular joint at 12.7 weeks and calcaneocuboid joint at 10.9 weeks]. Different union times between ankle, subtalar, talonavicular, and calcaneocuboid joint were not significant (p = 0.2571, Kruskal-Wallis Test Nonparametric ANOVA). All sites: [No graft] vs. [Autograft] vs. [Allograft]: p = 0.2421 (Kruskal-Wallis Test Nonparametric ANOVA), were not statistically significant. Complications included nonunion in 5 of 112 joints in 3 patients (4% joint nonunion rate; 4% patient nonunion rate) [subtalar joint, n = 2; talonavicular joint, n = 1; and calcaneocuboid joint, n = 1]. Two patients had wound complications and one other patient had a deep infection; all were successfully treated with local wound care, negative-pressure dressings and antibiotics.
CONCLUSION: We believe rhBMP-2 is an effective adjunct for bone healing in patients who undergo high-risk ankle and hindfoot fusions. Low complication rates were observed in this study.
Authors:
Christopher Bibbo; Dipak V Patel; Michelle D Haskell
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Foot & ankle international     Volume:  30     ISSN:  1071-1007     ISO Abbreviation:  Foot Ankle Int     Publication Date:  2009 Jul 
Date Detail:
Created Date:  2009-07-10     Completed Date:  2009-10-08     Revised Date:  2014-08-27    
Medline Journal Info:
Nlm Unique ID:  9433869     Medline TA:  Foot Ankle Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  597-603     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ankle Injuries / surgery*
Ankle Joint*
Arthrodesis*
Bone Morphogenetic Protein 2
Bone Morphogenetic Proteins / therapeutic use*
Cohort Studies
Female
Fracture Healing
Humans
Male
Middle Aged
Osteonecrosis / surgery*
Recombinant Proteins / therapeutic use*
Retrospective Studies
Tarsal Joints*
Transforming Growth Factor beta / therapeutic use*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Bone Morphogenetic Protein 2; 0/Bone Morphogenetic Proteins; 0/Recombinant Proteins; 0/Transforming Growth Factor beta; 0/recombinant human bone morphogenetic protein-2

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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