8 Cm Segmental Ulnar Defect Treated with Recombinant Human Bone Morphogenic Protein-2

Author(s): Schwartz NV, and Hicks BM

Source: Am J Orthop 37 (11): 569-71, 2008.

Summary:

The authors describe an off-label use of recombinant human BMP-2 on a post traumatic 8 cm bone defect in an ulna successfully treated with recombinant human bone morphogenic protein-2 (BMP-2), absorbable collagen sponge (ACS) along with calcium phosphate ceramic granules.  For bone defects larger than 5 cm, historical options have included amputation, bone transport, and vascularized bone transfers.  All of these options have potentially significant morbidity associated.  The authors report on an ulna that developed osteomyelitis after compression plating that required debridement, sequestrum removal, and placement of antibiotic beads leaving an 8 cm bone defect in the mid-shaft.  After eight weeks of IV antibiotics, the void was filled with a macro port sheath scaffold coupled with recombinant human BMP-2 solution prepared and soaked into an ACS carrier per the manufacturer’s instructions.  Additionally, 30 cm2  master graft granules were folded up into the recombinant BMP/ACS solution and placed into the defect. 

Another macroport sheath was placed over the top.  Radiographs were followed and consolidation of the defect was shown to continue over time with a twelve month radiograph showing complete consolidation.  The author’s further report on clinical and basic science studies showing the positive effects of recombinant BMP-2, and they conclude that recombinant human BMP-2/ACS implant is safe in humans and a valuable new option for the treatment of segmental bone defects. 

Albeit one case, this article provides an option of treating segmental defects with “off the shelf” materials.  It avoids the need for bone graft harvest and seems promising.  Certainly further study will be needed to evaluate this procedure for use on a more widespread basis.