Aims: Clinical use of BMP-7: actual situation The tibial pseudoarthrosis. The Friedlander paper can be considered the only golden standard about the clinical application. It is a prospective, randomized clinical trial comparing BMP-7 with fresh bone autograft. The results of the BMP-7 are similar under to use of fresh bone autograft. Some cases of very serious pseudoar-throsis treated with BMP-7 have demonstrated an high percentual of clinical recovery. In UOA of traumatology and in I Orthopaedic Clinic of Turin University the pseudoarthrosis are treated with the Ilizarov’s technique, not with the autologous transplantation, so Friedlander’s results are not discriminant for the our work.
Methods: In our department the guide lines for BMP-7 application are:
Delayed union of the docking point in pseudoarthrosis of long bones treated with the Ilizarov technique (resection and distractional osteogenesis) and traditional techniques (decortication and fresh bone autograft) not suitable for application. The treatment of a pseudoartrhosis is based on our classification in type: I, II, III, IV (septic).
Traditional techniques failure.
Choice first treatment in very difficult cases of limb reconstruction and bone nonunion.
Results: From 30/09/2002 till 28/02/2007 55 patients have been treated with BMP-7. In 5 cases it has been associated with autologus bone graft. The material is: 24 cases of traditional techniques failure, 17 cases in wich traditional techniques were unfeasible to be treated and 9 docking point nonunions, in 5 particular cases. Mean age is 38 years. Before last intervention, mean number of porevious operation is 6,5 with mean time before BMP procedures is 3 years. 43 patients healed, 9 are under treatment and 3 are failure. The mean time of healing was 4 months.
Conclusions: The series is strictly observational but results are effective in front of the complexity of cases. Late complications suggest that BMP-7 induces bone formation but mechanical function could need time to be achived.According to literature the BMP-7 should be usefull also in more simple cases but more prospective clinical double blind randomised series and cost decreasing are necessary to extend the indications for BMP-7 application.
