Internal fixation plus bone morphogenetic protein for prevention of bone nonunion after comminuted fracture of the shaft of long bones

doi:10.3969/j.issn.2095-4344.2014.43.003

Abstract

Abstract:

BACKGROUND: In the comminuted fractures of the shafts of long bones, the fracture repair process may be halted after internal fixation by locking compression plate and a higher bone nonunion rate occurs due to severe soft tissue damage, inadequate blood supply, poor cortical apposition, or unstable fracture fixation.
OBJECTIVE: To examine the effect of bone morphogenetic protein in the prevention of nonunion of long bone comminuted fractures after internal fixation by locking compression plate.
METHODS: Totally 145 long bone comminuted fracture patients were enrolled and randomly divided into test and control groups according to the wishes of patients. The test group included 78 patients (48 males and 30 females, 18-70 years old; 57 cases of closed fractures and 21 cases of open fractures) who were treated with internal fixation by locking compression plate combined with bone morphogenetic protein; the control group included 67 patients (42 males and 25 females, 18-71 years old; 49 cases of closed fractures and 18 cases of open fractures) who were treated with internal fixation by locking compression plate. The fracture healing time and rate of non-union were detected and compared in the two groups after a postoperative follow-up of 6-18 months.
RESULTS AND CONCLUSION: In the test group, the average fracture healing time was 6.17 months, without non-union. In the control group, the average fracture healing time was 7.24 months, and the rate of non-union was 7%. Compared with the control group, the fracture healing time was shorter and the rate of non-union was lower in the test group (P < 0.05). The use of bone morphogenetic protein is an effective method to shorten fracture healing time and prevent non-union of long bone comminuted fractures after internal fixation by locking compression plate.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: biocompatible materials, internal fixators, bone morphogenetic proteins, fractures, bone

CLC Number:

R318

Zhang Nu, Zhang Chun, Liu Shi-qing. Internal fixation plus bone morphogenetic protein for prevention of bone nonunion after comminuted fracture of the shaft of long bones[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(43): 6902-6906.

Figures/Tables 2

References

[1] Cantu RV, Koval GJ. The use of locking plates in fracture care. J Am Acad Orthop Surg. 2006;14(3):183-190.
[2] Erden ER, Arda C, Mesut SM, et al. Augmentative locking compression plate fixation for the management of long bone nonunion after intramedullary nailing. Arch Orthop Trauma Surg. 2012; 132(7):937-940.
[3] Erden ER, Arda C, Mesut SM, et al. Implementation of locking compression plate together with intramedullary fibular graft in atrophic type humeral nonunions. Eur J Orthop Surg Traumatol. 2012;22(8):661-665.
[4] Axelrad TW, Kakar S, Einhorn TA. New technologies for the enhancement of skeletal repair. Injury. 2007;38(Suppl) 1: S49-62.
[5] Fong K, Truong V, Foote CJ, et al. Predictors of nonunion and reoperation in patients with fractres of the tibia: an observational study. BMC Musculoskel Disord. 2013; 14: 103-112.
[6] Carofino BC, Lieberman JR. Gene therapy applications for fracture-healing. J Bone Joint Surg (Am). 2008; 90(Suppl 1): 99-110.
[7] Virk MS, Lieberman JR. Biologic adjuvants for fracture healing. Arth Res Ther. 2012;14:225-237.
[8] Chen D,Zhao M,Mundy GR. Bone morphogenetic proteins. Growth Factors. 2004;22:233-241.
[9] Lieberman JR,Daluiski A,Einhorn TA. The role of growth factors in the repair of bone. Biology and clinical applications. J Bone Joint Surg (Am). 2002;84:1032-1044.
[10] Patterson TE, Kumagai K, Griffith L, et al. Cellular strategies for enhancement of fracture repair. J Bone Joint Surg (Am) 2008;90 (Suppl 1):111-119.
[11] Urist MR. Bone: formation by autoinduction. Science 1965; 150:893-899.
[12] Govender S, Csimma C, Genant HK, et al. Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective，controlled，randomized study of four hundred and fifty patients. J Bone Joint Surg (Am). 2002; 84:2123-2134.
[13] Jones AL, Bucholz RW, Bosse MJ, et al. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial. J Bone Joint Surg (Am). 2006;88:1431-1441.
[14] Friedlaender GE, Perry CR, Cole JD, et al. Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg (Am). 2001;83 (Suppl 1): S151-158.
[15] Seeherman HJ, Li XJ, Bouxsein ML, et al. rhBMP-2 induces transient bone resorption followed by bone formation in a nonhuman primate core-defect model. J Bone Joint Surg (Am). 2010;92:411-426.
[16] Carragee EJ, Hurwitz EL, Weiner BK. A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery:emerging safety concerns and lessons learned. Spine. 2011;11:471-491.
[17] 沈如杰,叶建新.含重组人骨形态发生蛋白2骨修复材料的体内成骨实验[J].中国组织工程研究与临床康复,2008,12(36): 7012-7016.
[18] 叶建新,沈如杰.新型含重组人骨形态发生蛋白2骨修复材料的制备及生物学评价[J].中国组织工程研究与临床康复,2008,2(45): 8819-8822.
[19] Volpin G, Shtarker H. Management of Delayed Union, Non-Union and Mal-Union of Long Bone Fractures. Eur Surg Orthop Traumatol. 2014; 241-266.
[20] Niikura Y, Lee SY, Sakai Y, et al. Causative factors of fracture nonunion: the proportionsof mechanical, biological, patient-dependent, and patient-independent factors. J Orthop Sci. 2014;19:120-124.
[21] 蒋恒,徐国红.成人骨干骨折手术治疗后骨不愈合的预防[J].浙江创伤外科,2011,16(4):507-509.
[22] 危伟浪.股骨干骨折不愈合的原因及相关因素分析[J].局解手术学杂志,2012,21(4):439-440.
[23] 王庆生.股骨干骨折钢板内固定术后不愈合21例原因分析[J].中国医药导报,2008,5(32):143-144.
[24] 常宇明.股骨干骨折钢板内固定术后不愈合的临床分析[J].中国现代药物应用,2008,2(9):93-94.
[25] 武玉江,宋景仑.骨折钢板内固定不愈合影响因素分析[J].当代医学,2011,17(33):74-75.
[26] 陈爽.胫骨中下段骨折内固定术后骨不愈合原因分析[J]. 医药论坛杂志,2009,30(1):33-34.
[27] Kanakaris NK, Paliobeis C, Manidakis N, et al. Biological enhancement of tibial diaphyseal aseptic non-unions：the efficacy of autologous bone grafting, BMPs and reaming by-products. Injury. 2007;38(Supple 2): 65-75.
[28] Khan SN, Cammisa FP Jr, Sandhu HS, et al. The biology of bone grafting. J Am Acad Orthop Surg. 2005;13:77-86.
[29] Dahabreh Z, Calori GM, Kanakaris NK, et al. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop. 2009;(33): 1407-1414.
[30] Dahabreh Z, Dimitriou R, Giannoudis PV. Health economics. a cost analysis of treatment of persistent fracture non-unions using bone morphogenetic protein-7. Injury. 2007;38:371-377.
[31] Kanakaris NK, Giannoudis PV. The health economics of the treatment of long-bone non-unions. Injury. 2007;38(Supple 2): 77-84.