Bone Morphogenetic Protein in Scaphoid Nonunion: A Systematic Review.
Michael M Polmear1, Ashley B Anderson2, Paul J Lanier1
1Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas.
Journal of Wrist Surgery
|June 10, 2021
Summary
Bone morphogenetic protein (BMP) aids scaphoid nonunion healing with a 90.5% union rate. However, complications like heterotopic ossification occurred, necessitating further research for optimal use in surgical treatments.
Area of Science:
- Orthopedic surgery
- Regenerative medicine
- Bone healing
Background:
- Scaphoid nonunion can cause carpal instability and osteoarthritis.
- Bone morphogenetic protein (BMP) shows promise for bone healing but has conflicting results in scaphoid nonunion.
- Surgical intervention is often required for scaphoid nonunion.
Purpose of the Study:
- To evaluate the outcomes and complications of surgically treated scaphoid nonunion using BMP.
- To review existing literature on BMP augmentation in scaphoid nonunion surgery.
Main Methods:
- A literature review of studies from 2002-2019 using BMP for scaphoid nonunion surgery.
- Inclusion of primary and revision surgeries with CT confirmation of union.
- Data collection on demographics, BMP dosage, tobacco use, outcomes, and complications from 21 cases across four studies.
Main Results:
- Overall union rate of 90.5% (100% for primary, 77.8% for revision surgeries).
- Eleven complications in 24% of patients, including heterotopic ossification in 19%.
- BMP was used as an adjunct to bone grafting and/or fixation methods.
Conclusions:
- BMP demonstrates a high union rate in scaphoid nonunion surgery but is associated with complications like heterotopic ossification.
- The overall efficacy of BMP in scaphoid nonunion remains uncertain.
- A high-powered randomized controlled trial is needed to establish optimal BMP use, fixation, dosing, and safety profiles.
