OTA 1997 Posters - Tibia Fractures

Poster #64

*Osteogenic Protein (OP-1) vs Autograft in the Management of Tibial Nonunions

Clayton R. Perry, MD, Dean Cole, MD, Monica Perry, George Cierny, MD

St. Louis, Missouri, USA

Hypothesis: We compared the efficacy of OP-1 with autogenous bone graft in the management of tibial non-unions.

Methods: OP-1 is one of the Bone Morphogenetic Proteins. This group of proteins has been shown to stimulate bone formation in vivo. The OP-1 used in this study was synthesized using recombinant DNA techniques. Forty-one patients with nonunions amenable to intramedullary nailing were prospectively randomized into the OP-1 group or the autograft group. All patients underwent open intramedullary nailing of their tibial nonunions and placement of either OP-1 (n=20) or autograft (n=21) in and around the nonunion site. All patients have been followed clinically and radiographically for a minimum of 1 year.

Results: Risk factors including: duration of nonunion, number of prior surgeries and smoking history were similar in OP-1 and autograft groups. Treatment parameters including: operative time, and duration of hospitalization, were similar in both groups. Nineteen of 20 nonunions consolidated in the OP-1 group. Seventeen of 21 consolidated in the autograft group. The cost of treatment with OP-1 was compared with cost of treatment with autograft in 18 patients (9 in each group) treated at one hospital. Cost of OP-1 treatment ranged from $10,279 to $15,097 (m= $12,468). Cost of autograft treatment ranged from $7,236 to $19,395 (m= $12,755). There were no complications associated with the OP-1 (e.g., allergic reaction). As expected, patients in the autograft group experienced severe, but temporary, pain at the autograft site.

Conclusion: The incidence of nonunion consolidation was higher in the OP-1 group. Cost of treatment with OP-1 was slightly less than with autograft. Patients in the OP-1 group were spared donor site symptoms. OP-1 is an alternative to autogenous bone graft in the management of nonunions of the tibia.