Abstract
Introduction: Nonunion is a relatively common complication seen in orthopaedic practice. The treatment of nonunion has traditionally been revision fixation with autogenic bone grafting. Here we present our results of nonunion treatment using Osteogenic Protein -1 (OP1) and allograft paste.
Material and Methods: Forty Eight Patients with resistant nonunion including atropic, hypertrophic and infected nonunion were treated with a composite of osteogenic protein-1 and allograft paste. The series consisted of 28 males and twenty females. Average age was 54 years. The average duration of preoperative symptoms was 26 months (range 4 to 52). 28 of 48 patients had an average of three prior failed surgical attempts at union (range 1 to 6). There were thirty seven atrophic, four hypertrophic and seven infected nonunions (bone transport docking site nonunion).18 patients in the series had previous autogenic cancellous bone grafting to the fracture site for attempted union. 39 patients had revision internal fixation with application of OP-1 and allograft paste to the nonunion site. Average healing time was 6.5 months (Range 3.5–19). Three patients in this series had OP-1 insertion twice, one patient simultaneously had autogenic cancellous bone grafting with OP-1.
Results: Average follow-up was 16 months (range 4 to 38). Functional and radiological outcome was excellent in 33 patients, good in five patients and fair in three. 3 cases were ongoing. Three patients went on to non-union requiring revision surgery and are under review. One patient died during follow-up.
Conclusion: Results in our series indicate OP-1 (BMP-7) implanted with Opteform allograft paste are as effective as autogenic cancellous bone grafting in treating resistant bone nonunions.
The abstracts were prepared by Mr Matt Costa and Mr Ben Ollivere. Correspondence should be addressed to Mr Costa at Clinical Sciences Research Institute, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK.
