Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report
Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fr...
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| Veröffentlicht in: | Clinical orthopaedics and related research 2009-12, Vol.467 (12), p.3257-3262 |
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| description | Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fracture healing, few articles describe complications of BMP. In tibial plateau fractures, after elevating the cartilage en mass, a subchondral void may be created in these fractures. Structural support provided by bone void-filling agents can be augmented with osteoinduction achieved by BMP. We asked whether heterotopic bone formation would occur more frequently with BMP-2 when used in tibial plateau fractures and whether BMP-2 enhanced the ability to maintain surgically restored subchondral bone integrity. Heterotopic bone developed more frequently in patients receiving BMP (10 of 17) than in patients not receiving BMP (one of 23). Four patients receiving BMP and no patients not receiving BMP underwent removal of heterotopic bone. Maintenance of subchondral bone integrity was similar without and with the use of BMP. BMP is a potent osteoinductive agent; however, when used for an off-label indication in periarticular situations, complications such as heterotopic bone are common and increase reoperation rates.
Level of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. |
| doi_str_mv | 10.1007/s11999-009-1039-8 |
| format | Article |
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Level of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-009-1039-8</identifier><identifier>PMID: 19693635</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bone Morphogenetic Protein 2 - administration & dosage ; Bone Morphogenetic Protein 2 - adverse effects ; Bone Transplantation ; Collagen Type I ; Combined Modality Therapy ; Conservative Orthopedics ; Drug Carriers ; Female ; Fracture Healing - drug effects ; Humans ; Logistic Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Orthopedics ; Ossification, Heterotopic - chemically induced ; Ossification, Heterotopic - diagnostic imaging ; Ossification, Heterotopic - surgery ; Pilot Projects ; Radiography ; Recombinant Proteins - adverse effects ; Reoperation ; Retrospective Studies ; Risk Assessment ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors ; Tibial Fractures - diagnostic imaging ; Tibial Fractures - drug therapy ; Tibial Fractures - physiopathology ; Tibial Fractures - surgery ; Time Factors ; Transplantation, Homologous ; Treatment Outcome ; Young Adult</subject><ispartof>Clinical orthopaedics and related research, 2009-12, Vol.467 (12), p.3257-3262</ispartof><rights>The Association of Bone and Joint Surgeons® 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c534t-9d755f9890c12a5a9011bcdd72f3a6196935ff08ed5f06569c6c63b059744f2c3</citedby><cites>FETCH-LOGICAL-c534t-9d755f9890c12a5a9011bcdd72f3a6196935ff08ed5f06569c6c63b059744f2c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772910/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2772910/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19693635$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boraiah, Sreevathsa</creatorcontrib><creatorcontrib>Paul, Omesh</creatorcontrib><creatorcontrib>Hawkes, David</creatorcontrib><creatorcontrib>Wickham, Matthew</creatorcontrib><creatorcontrib>Lorich, Dean G.</creatorcontrib><title>Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fracture healing, few articles describe complications of BMP. In tibial plateau fractures, after elevating the cartilage en mass, a subchondral void may be created in these fractures. Structural support provided by bone void-filling agents can be augmented with osteoinduction achieved by BMP. We asked whether heterotopic bone formation would occur more frequently with BMP-2 when used in tibial plateau fractures and whether BMP-2 enhanced the ability to maintain surgically restored subchondral bone integrity. Heterotopic bone developed more frequently in patients receiving BMP (10 of 17) than in patients not receiving BMP (one of 23). Four patients receiving BMP and no patients not receiving BMP underwent removal of heterotopic bone. Maintenance of subchondral bone integrity was similar without and with the use of BMP. BMP is a potent osteoinductive agent; however, when used for an off-label indication in periarticular situations, complications such as heterotopic bone are common and increase reoperation rates.
Level of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bone Morphogenetic Protein 2 - administration & dosage</subject><subject>Bone Morphogenetic Protein 2 - adverse effects</subject><subject>Bone Transplantation</subject><subject>Collagen Type I</subject><subject>Combined Modality Therapy</subject><subject>Conservative Orthopedics</subject><subject>Drug Carriers</subject><subject>Female</subject><subject>Fracture Healing - drug effects</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Orthopedics</subject><subject>Ossification, Heterotopic - chemically induced</subject><subject>Ossification, Heterotopic - diagnostic imaging</subject><subject>Ossification, Heterotopic - surgery</subject><subject>Pilot Projects</subject><subject>Radiography</subject><subject>Recombinant Proteins - adverse effects</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors</subject><subject>Tibial Fractures - diagnostic imaging</subject><subject>Tibial Fractures - drug therapy</subject><subject>Tibial Fractures - physiopathology</subject><subject>Tibial Fractures - surgery</subject><subject>Time Factors</subject><subject>Transplantation, Homologous</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1UU1LKzEUDaJorf4AN4_w9qP5mMxM3kLQolZQLFLBXchkkhqZSWoyI_rvTW1R38LV5XI-7uEeAI4wOsYIlScRY855hhDPMKI8q7bACDNSZRhTsg1GaIVwgh_3wH6Mz2mlOSO7YA_zgtOCshFoJ75btlbJ3noXoTfwXivf1dZJ18Pp0EkHz29nGYHGBzgPOhHdAn6q9Buc29rKFs5a2Ws5wMsgVT8EHf_BMzgLurVdMgrvyXTpQ38Adoxsoz7czDF4uLyYT6bZzd3V9eTsJlOM5n3Gm5IxwyuOFCaSSY4wrlXTlMRQWXxmZ8agSjfMoIIVXBWqoDVivMxzQxQdg9O173KoO90o7fogW7EMtkthhJdW_I84-yQW_lWQsiQ8vXIM_m4Mgn8ZdOzFsx-CS5kFobQoKcnLRMJrkgo-xqDN1wGMxKofse5HpBbEqh9RJc2fn8m-FZtCEoGsCTFBbqHD9-XfXT8A-PqcCQ</recordid><startdate>20091201</startdate><enddate>20091201</enddate><creator>Boraiah, Sreevathsa</creator><creator>Paul, Omesh</creator><creator>Hawkes, David</creator><creator>Wickham, Matthew</creator><creator>Lorich, Dean G.</creator><general>Springer-Verlag</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20091201</creationdate><title>Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report</title><author>Boraiah, Sreevathsa ; Paul, Omesh ; Hawkes, David ; Wickham, Matthew ; Lorich, Dean G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c534t-9d755f9890c12a5a9011bcdd72f3a6196935ff08ed5f06569c6c63b059744f2c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bone Morphogenetic Protein 2 - administration & dosage</topic><topic>Bone Morphogenetic Protein 2 - adverse effects</topic><topic>Bone Transplantation</topic><topic>Collagen Type I</topic><topic>Combined Modality Therapy</topic><topic>Conservative Orthopedics</topic><topic>Drug Carriers</topic><topic>Female</topic><topic>Fracture Healing - drug effects</topic><topic>Humans</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Orthopedics</topic><topic>Ossification, Heterotopic - chemically induced</topic><topic>Ossification, Heterotopic - diagnostic imaging</topic><topic>Ossification, Heterotopic - surgery</topic><topic>Pilot Projects</topic><topic>Radiography</topic><topic>Recombinant Proteins - adverse effects</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors</topic><topic>Tibial Fractures - diagnostic imaging</topic><topic>Tibial Fractures - drug therapy</topic><topic>Tibial Fractures - physiopathology</topic><topic>Tibial Fractures - surgery</topic><topic>Time Factors</topic><topic>Transplantation, Homologous</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boraiah, Sreevathsa</creatorcontrib><creatorcontrib>Paul, Omesh</creatorcontrib><creatorcontrib>Hawkes, David</creatorcontrib><creatorcontrib>Wickham, Matthew</creatorcontrib><creatorcontrib>Lorich, Dean G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boraiah, Sreevathsa</au><au>Paul, Omesh</au><au>Hawkes, David</au><au>Wickham, Matthew</au><au>Lorich, Dean G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2009-12-01</date><risdate>2009</risdate><volume>467</volume><issue>12</issue><spage>3257</spage><epage>3262</epage><pages>3257-3262</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Bone morphogenic proteins (BMPs) are potent osteoinductive agents. Their use in fracture surgery is still being studied and the clinical indications are evolving. Heterotopic bone after BMP use in spine surgery is a known complication. While some literature describes the ability of BMP to enhance fracture healing, few articles describe complications of BMP. In tibial plateau fractures, after elevating the cartilage en mass, a subchondral void may be created in these fractures. Structural support provided by bone void-filling agents can be augmented with osteoinduction achieved by BMP. We asked whether heterotopic bone formation would occur more frequently with BMP-2 when used in tibial plateau fractures and whether BMP-2 enhanced the ability to maintain surgically restored subchondral bone integrity. Heterotopic bone developed more frequently in patients receiving BMP (10 of 17) than in patients not receiving BMP (one of 23). Four patients receiving BMP and no patients not receiving BMP underwent removal of heterotopic bone. Maintenance of subchondral bone integrity was similar without and with the use of BMP. BMP is a potent osteoinductive agent; however, when used for an off-label indication in periarticular situations, complications such as heterotopic bone are common and increase reoperation rates.
Level of Evidence:
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>19693635</pmid><doi>10.1007/s11999-009-1039-8</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Bone Morphogenetic Protein 2 - administration & dosage Bone Morphogenetic Protein 2 - adverse effects Bone Transplantation Collagen Type I Combined Modality Therapy Conservative Orthopedics Drug Carriers Female Fracture Healing - drug effects Humans Logistic Models Male Medicine Medicine & Public Health Middle Aged Orthopedics Ossification, Heterotopic - chemically induced Ossification, Heterotopic - diagnostic imaging Ossification, Heterotopic - surgery Pilot Projects Radiography Recombinant Proteins - adverse effects Reoperation Retrospective Studies Risk Assessment Sports Medicine Surgery Surgical Orthopedics Symposium: Tribute to Dr. Marshall Urist: Musculoskeletal Growth Factors Tibial Fractures - diagnostic imaging Tibial Fractures - drug therapy Tibial Fractures - physiopathology Tibial Fractures - surgery Time Factors Transplantation, Homologous Treatment Outcome Young Adult |
| title | Complications of Recombinant Human BMP-2 for Treating Complex Tibial Plateau Fractures: A Preliminary Report |
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