Session I - Polytrauma / Pelvis / Post-Traumatic Reconstruction

Thurs., 10/10/13 Polytrauma/Pelvis/Post-Trauma, PAPER #36, 4:23 pm OTA 2013

•Recombinant Human Morphogenetic Protein-2 (rhBMP-2) Versus Iliac Crest Autograft to Treat Tibia Nonunion: A Retrospective Multicenter Study

Southeast Fracture Consortium; William T. Obremskey, MD, MPH;
Vanderbilt University Medical Center, Nashville, Tennessee, USA

Background/Purpose: There is no consensus opinion on the use of recombinant human morphogenetic protein (rhBMP) in the treatment of tibia fracture nonunions. Avoidance of complications associated with iliac crest autograft harvesting has led to a high level of off-label rhBMP-2 use to treat fracture nonunions. Complications with the use of off-label rhBMP-2 in cervical fusion have raised interest in the off-label use of rhBMP-2 in orthopaedic trauma. The purpose of this study was to retrospectively examine the union rate and adverse events associated with the use of rhBMP-2 compared to iliac crest autograft for the treatment of tibia nonunions.

Methods: We retrospectively reviewed the management of all consecutive tibia nonunions in patients who were treated with either rhBMP-2 (n = 33) or iliac crest autograft (n = 132) between January 1, 2002 and December 31, 2008 at five Level I orthopaedic trauma centers. Clinical records and radiographs were reviewed to determine the rate of fracture union and incidence of adverse events.

Results: The two intervention groups were statistically similar. The healing rates were 84.9% and 74.2% for the rhBMP-2 and iliac crest autograft groups respectively (P = 0.20). Bivariate logistic regression analysis comparing rhBMP-2 and iliac crest autograft with fracture union revealed an odds ratio (OR) of 1.94 favoring rhBMP-2, but this was not statistically significant (95% confidence interval [CI]: 0.69-5.43, P = 0.21). While controlling for age, gender, prior infection, and intramedullary fixation, the OR comparing rhBMP-2 and iliac crest was 2.01 (95% CI: 0.70-5.82, P = 0.20). The length of stay was statistically significant favoring the rhBMP-2 group (2.7 days vs 3.6 days, P = 0.005).

Conclusion: In a retrospective, multicenter study, rhBMP-2 appears to have similar union rates compared to iliac crest autograft in the treatment of atrophic or oligotrophic tibia nonunions. Our data revealed a statistically significant shorter length of stay for patients treated with rhBMP-2 compared to iliac crest autograft.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.