[Therapy-resistant tibial pseudarthrosis. Treatment success with BMP-7 combined with autologous bone]

Delayed union or non-union of long bone shaft fractures still presents a surgical challenge. Especially if there is a predisposition for pseudarthrosis such as adiposity, diabetes mellitus, local disruption of blood supply or lack of hormones, the established procedures of autologous cancellous bone grafting or plate fixation with compression often lead to insufficient results. In the following article the successful use of bone morphogenetic protein BMP-7 [recombinant human osteogenetic protein-1 (rhOP-1)], combined with autologous bone grafting for therapy of a therapy-resistant tibial non-union is described. In a patient with multiple risk factors the tibial fracture was completely cured after two attempts of osteosynthesis and autologous bone grafting had failed. The patient achieved self-mobility with full weight bearing and absence of pain 10 months after adjuvant implantation of BMP-7.