Simon H et al. – This study evaluated the long term outcome following additional recombinant human Bone Morphogenetic Protein–7 (rhBMP–7) application during surgical revision for the treatment of aseptic humeral, femoral, and tibial diaphyseal nonunion. In addition, the time range for bone healing, clinical and radiological long–term outcome compared to no additional rhBMP–7 use was determined. The authors concluded that healing of aseptic diaphyseal nonunion in humerus, femur, and tibia occurred irrespective of additional rhBMP–7 application. The study also suggested that radical removal of nonunion tissue, stable fixation and restoration of axis, length and torsion can be used to link successful nonunion healing to precise surgical concepts, rather than to the additional use of signaling proteins.

Methods

• A retrospective comparative study was conducted between 06/2006 and 05/2013 in 112 patients diagnosed with aseptic diaphyseal humerus (22 patients), femur (41 patients), and tibia (49 patients) nonunion treated using internal fixation and bone graft augmentation.
• Growth factor rhBMP–7 was locally administered in 62 out of 112 patients for additional stimulation of bone healing with subsequent follow–up studies including clinical and radiological assessment at regular intervals and at least one year following nonunion surgery.

Results

• At the end of 12 months after revision surgery, nonunion healing in 102 out of 112 (humerus: 19, femur: 37, tibia: 47) occurred with no significant difference between the cohort groups.
• According to the Disabilities of the Arm, Shoulder and Hands (DASH) outcome measure for the humerus (P = .679), LEFS for the femur (P = .251) and the tibia (P = .946) as well as to the SF–12 for all entities, no significant differences were found between the treatment groups.