Purpose
In an effort to improve fracture healing and decrease the need for autologous bone
graft, products such as recombinant human bone morphogenetic protein (rhBMP-2) have
been developed and used in both spine and nonspine surgery. There is a paucity of
literature regarding the use of rhBMP-2 in scaphoid nonunion surgery with very little
reporting on the complications associated with its use. The objective of this study
was to retrospectively review the complications documented for a case series of patients
treated with revision fixation, bone graft, and rhBMP-2 in revision scaphoid nonunion
surgery.
Methods
We retrospectively reviewed 6 cases of scaphoid nonunion revision surgery comprising
open reduction and internal fixation (ORIF). All cases were performed for persistent
nonunion after a previous scaphoid ORIF. All patients were treated with revision screw
fixation, bone graft, and rhBMP-2. Union was determined by computed tomography in
all cases. Complications of nonunion, heterotopic bone formation, delayed wound healing,
functional loss of motion, and need for revision surgery are reported.
Results
Between 2011 and 2014, 6 cases in which rhBMP-2 was used in revision scaphoid nonunion
surgery were identified. All patients had failed an initial attempt at ORIF after
delayed union or nonunion. The time from injury to index ORIF ranged from 3 months
to 4 years (mean, 24 months). Revision surgery with rhBMP-2 was performed at an average
of 6 months from the index ORIF. Of the 6 cases, 2 had resultant persistent nonunion.
Both underwent scaphoid excision and midcarpal arthrodesis. Four cases developed notable
heterotopic ossification (one of which required revision surgery). One patient had
a loss of functional motion after the revision surgery. There were no cases of delayed
wound healing. Only one of the 6 patients healed without complications.
Conclusions
In this case series, the use of rhBMP-2 in scaphoid nonunions was associated with
a higher complication rate than reported in previous studies. Surgeons performing
off-label use of rhBMP-2 should be aware of the potential for complications including
heterotopic ossification.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: March 22, 2016
Accepted:
January 22,
2016
Received:
July 14,
2015
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2016 ASSH. Published by Elsevier Inc. All rights reserved.
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