Foot & ankle international · 2009
Recombinant bone morphogenetic protein-2 (rhBMP-2) in high-risk ankle and hindfoot fusions.
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Bibbo Christopher, Patel Dipak V, Haskell Michelle D
Аннотация
BACKGROUND: The purpose of this study was to evaluate the effect of rhBMP-2 on bone healing in patients who undergo high-risk ankle & hindfoot fusions.
MATERIALS & METHODS: Patients who underwent high-risk, elective ankle and hindfoot fusions treated with rhBMP-2 augmentation were reviewed for clinical outcomes and complications. A total of 112 fusion sites (69 patients) were reviewed for analysis. The mean age of the patients was 52 years (range, 21 to 84 years). There were 37 males (53%) and 32 females (47%). Forty-four patients (64%) were smokers and 13 patients (19%) were diabetic. A history of high-energy trauma was present in 47 (68%) patients and avascular necrosis of the talus was present in 22 patients (32%). Forty-five patients (65%) had multiple risk-factors. The exclusion criteria were peripheral vascular disease, infection, and patients who were not available for the usual follow-up protocol. Internal and/or external fixation was utilized for ankle and hindfoot fusions. Bone graft was used only for patients who had defects or malalignment. Postoperatively, nonweightbearing radiographs were taken every 2 to 4 weeks (3 views per site). When plain radiographic union was evident, a confirmatory CT scan was obtained.
RESULTS: Overall, 108 fusion sites went on to union (96% union rate) at a mean time of 11 weeks (as assessed by a CT scan) [ankle joint at 10 weeks; subtalar joint at 12.3 weeks; talonavicular joint at 12.7 weeks and calcaneocuboid joint at 10.9 weeks]. Different union times between ankle, subtalar, talonavicular, and calcaneocuboid joint were not significant (p = 0.2571, Kruskal-Wallis Test Nonparametric ANOVA). All sites: [No graft] vs. [Autograft] vs. [Allograft]: p = 0.2421 (Kruskal-Wallis Test Nonparametric ANOVA), were not statistically significant. Complications included nonunion in 5 of 112 joints in 3 patients (4% joint nonunion rate; 4% patient nonunion rate) [subtalar joint, n = 2; talonavicular joint, n = 1; and calcaneocuboid joint, n = 1]. Two patients had wound complications and one other patient had a deep infection; all were successfully treated with local wound care, negative-pressure dressings and antibiotics.
CONCLUSION: We believe rhBMP-2 is an effective adjunct for bone healing in patients who undergo high-risk ankle and hindfoot fusions. Low complication rates were observed in this study.
MATERIALS & METHODS: Patients who underwent high-risk, elective ankle and hindfoot fusions treated with rhBMP-2 augmentation were reviewed for clinical outcomes and complications. A total of 112 fusion sites (69 patients) were reviewed for analysis. The mean age of the patients was 52 years (range, 21 to 84 years). There were 37 males (53%) and 32 females (47%). Forty-four patients (64%) were smokers and 13 patients (19%) were diabetic. A history of high-energy trauma was present in 47 (68%) patients and avascular necrosis of the talus was present in 22 patients (32%). Forty-five patients (65%) had multiple risk-factors. The exclusion criteria were peripheral vascular disease, infection, and patients who were not available for the usual follow-up protocol. Internal and/or external fixation was utilized for ankle and hindfoot fusions. Bone graft was used only for patients who had defects or malalignment. Postoperatively, nonweightbearing radiographs were taken every 2 to 4 weeks (3 views per site). When plain radiographic union was evident, a confirmatory CT scan was obtained.
RESULTS: Overall, 108 fusion sites went on to union (96% union rate) at a mean time of 11 weeks (as assessed by a CT scan) [ankle joint at 10 weeks; subtalar joint at 12.3 weeks; talonavicular joint at 12.7 weeks and calcaneocuboid joint at 10.9 weeks]. Different union times between ankle, subtalar, talonavicular, and calcaneocuboid joint were not significant (p = 0.2571, Kruskal-Wallis Test Nonparametric ANOVA). All sites: [No graft] vs. [Autograft] vs. [Allograft]: p = 0.2421 (Kruskal-Wallis Test Nonparametric ANOVA), were not statistically significant. Complications included nonunion in 5 of 112 joints in 3 patients (4% joint nonunion rate; 4% patient nonunion rate) [subtalar joint, n = 2; talonavicular joint, n = 1; and calcaneocuboid joint, n = 1]. Two patients had wound complications and one other patient had a deep infection; all were successfully treated with local wound care, negative-pressure dressings and antibiotics.
CONCLUSION: We believe rhBMP-2 is an effective adjunct for bone healing in patients who undergo high-risk ankle and hindfoot fusions. Low complication rates were observed in this study.
Предметные рубрики MeSH
AdultAgedAged, 80 and overAnkle InjuriesAnkle JointArthrodesisBone Morphogenetic Protein 2Bone Morphogenetic ProteinsCohort StudiesFemaleFracture HealingHumansMaleMiddle AgedOsteonecrosisRecombinant ProteinsRetrospective StudiesTarsal JointsTransforming Growth Factor betaTreatment OutcomeYoung Adult