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Masquelet's procedure and bone morphogenetic protein in congenital pseudarthrosis of the tibia in children: a case
1Pediatric Surgery Department, North Hospital, Jean Monnet University of Saint Etienne, 42055 Saint Etienne, France.
Insights
Masquelet's procedure allowed bone reconstruction in congenital pseudarthrosis of the tibia (CPT). However, recombinant human bone morphogenetic protein-2 (rhBMP2) showed a lower healing rate than expected for CPT treatment.
Area of Science:
- Orthopedic surgery
- Regenerative medicine
- Pediatric orthopedics
Background:
- Congenital pseudarthrosis of the tibia (CPT) is a challenging condition.
- Pathologic tissues may impede healing in CPT.
- Masquelet's procedure and rhBMP2 are used for long bone defects.
Purpose of the Study:
- To evaluate the efficacy of Masquelet's procedure combined with rhBMP2 in treating CPT in children.
- To investigate the hypothesis that large segmental resection of pseudarthrosis improves CPT prognosis.
Main Methods:
- Reported three pediatric cases of CPT treated with Masquelet's procedure and rhBMP2.
- Analyzed published cases of CPT treated with similar methods.
Main Results:
- Segmental bone reconstruction was achieved using Masquelet's procedure.
- Bone healing occurred in 3 out of 5 rhBMP2 applications in the study.
- Literature review of 33 cases showed a 62% healing rate with BMP for CPT.
Conclusions:
- Masquelet's procedure enables segmental bone reconstruction in CPT.
- rhBMP2 application in CPT appears to have a lower success rate than traditional methods.
- Careful patient selection is crucial due to potential risks associated with BMP use in pediatric CPT.
Purpose:
A type 2 recombinant human bone morphogenetic protein (rhBMP2) and Masquelet's procedure were used in three children presenting with congenital pseudarthrosis of the tibia (CPT). Recent studies on CPT suggested the presence in situ of pathologic tissues promoting pseudarthrosis. The authors hypothesized that large segmental resection of pseudarthrosis could improve prognosis of the CPT. Masquelet's procedure and rhBMP2 have been advocated for the treatment of long bone defect.
Method:
The authors report three cases of CPT in children treated with Masquelet's procedure and application of rhBMP2. They analyzed all published cases of CPT similarly treated.
Results:
In the present study, Masquelet's procedure did not improve the results in the treatment of CPT, but segmental bone reconstruction was possible. Bone healing was obtained in three out of the five applications of rhBMP2. In one case, the patient's parents asked for leg amputation. Analysis of the 33 published cases with the application of BMP in CPT points to a 62 % healing rate in this pathology.
Conclusion:
The authors confirmed that segmental bone reconstruction is possible in CPT using Masquelet's procedure. In the literature, the success rate of the application of rhBMP in CPT appears to be lower than the healing rate usually reported without BMP. Nevertheless, the strict selection of patients, limited number of cases, and their heterogeneity make interpreting the results difficult. However, the theoretical risk which the children are exposed to during the use of BMP makes rigorous selection of the indications necessary. Finally, the interest of rhBMP2 application in Masquelet's procedure remained to be proven.
