Effect of Bone Morphogenetic Protein-2 in the Treatment of Long Bone Non-Unions
Open accessAbstract
Background: Delayed fracture healing continues to cause significant patient morbidity and an economic burden to society. Biological stimulation of non-unions includes application of recombinant bone morphogenetic protein-2 (rhBMP-2). However, rhBMP-2 use continues to be a matter of controversy as literature shows scarce evidence for treatment effectiveness. Questions: The objective of this study was to evaluate the effectiveness of rhBMP-2 treatment on long bone non-unions measuring union rate and time to union. Furthermore, we assess risk factors for treatment failure. Methods and patients: A total of 91 patients with non-unions of long bones were treated with rhBMP-2 (n = 72) or standard care without BMP (n = 19) at our institution. Patient characteristics, comorbidities, nicotine consumption, and complications were recorded. Bone healing was assessed by plane X-rays and clinical examination. Patients were followed up with for 24 months. Results: Overall, there was significantly faster bone healing after rhBMP-2 application compared to the no-BMP group (p < 0.001; HR = 2.78; 95% CI 1.4–5.6). Union rates differed significantly between rhBMP-2 compared to the no-BMP group (89% vs. 47%; p < 0.001). At the humerus, there was neither a significantly higher union rate in the rhBMP-2 (83%) compared to the no-BMP group (50%) (p = 0.26; n = 12) nor a faster bone healing with a median time of 9 months in both groups (HR = 2.01; 95% CI 0.49–8.61; p = 0.315). The 33 femora treated using rhBMP-2 healed significantly faster than 9 femora in the no-BMP group (HR = 2.93; 95% CI 1.00–8.4; p = 0.023) with significant differences in union rate with 85% and 44%, respectively (p = 0.022). Regarding tibia non-unions, 25 out of 27 (93%) healed with a median of 9 months after rhBMP-2 application with no significant difference in the no-BMP group (33%) in time to union (p = 0.097) but a significantly higher union rate (p = 0.039). There was no effect of comorbidities, age, sex, soft tissue damage, or nicotine use on time to union, union rate, or secondary interventions. Conclusion: Consistent with the literature, overall, significantly higher union rates with reduced time to union were achieved after rhBMP-2 application. Femoral and tibial non-unions in particular seem to profit from rhBMP-2 application.
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References 41 · Cited by 36
- Authors
- Fuchs, T., Stolberg-Stolberg, J., Michel, P. A., Garcia, P., Amler, S., Wähnert, D., & Raschke, M. J.
- Affiliations
- Klinikum im Friedrichshain (DE)
- University Hospital Münster (DE)
- University of Münster (DE)
- Bielefeld University (DE)
- Department of Trauma-, Hand- and Reconstructive Surgery, Albert-Schweitzer-Campus 1, University Hospital Muenster, Building W1, 48149 Muenster, Germany
- Corresponding author
- Stolberg-Stolberg, Josef
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2021-10-06
- Volume
- 10
- Issue
- 19
- Pages
- 4597
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC8509770
- OpenAlex
- W3204780930
- Cited by
- 36
- References
- 41
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 8 · 2023: 6 · 2022: 3 · 2020: 1
- FWCI
- 3.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- URN:NBN Resolver for Germany & Switzerland (German National Library) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Publikationen an der Universität Bielefeld (Universität Bielefeld) (submittedVersion, cc-by)
- Universitäts- und Landesbibliothek Münster (cc-by)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Bone Tissue Engineering Materials
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- BMP-2, rhBMP-2, long bone nonunion, delayed fracture healing, bone union rate, time to union, risk factors for treatment failure, humerus, femur, tibia, nicotine use, cost-effectiveness, patient satisfaction, patient-reported outcomes
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