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J Wrist Surg 2021; 10(03): 184-189
DOI: 10.1055/s-0040-1722332
Special Review: Bone Morphogenetic Protein for Scaphoid Nonunion

Bone Morphogenetic Protein in Scaphoid Nonunion: A Systematic Review

Michael M. Polmear 
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
,
Ashley B. Anderson
2   Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Paul J. Lanier
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
,
Justin D. Orr
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
,
Leon J. Nesti
3   Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
,
John C. Dunn
1   Department of Orthopaedic Surgery, William Beaumont Army Medical Center, El Paso, Texas
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Funding None.
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Abstract

Background Scaphoid nonunion can lead to carpal collapse and osteoarthritis, a painfully debilitating problem. Bone morphogenetic protein (BMP) has been successfully implemented to augment bone healing in other circumstances, but its use in scaphoid nonunion has yielded conflicting results.

Case Description The purpose of this study is to assess the outcomes and complications of scaphoid nonunion treated surgically with BMP.

Literature Review A literature review of all available journal articles citing the use of BMP in scaphoid nonunion surgery from 2002 to 2019 was conducted. We included studies that used BMP as an adjunct to surgical treatment for scaphoid nonunions in both the primary and revision settings with computed tomography determination of union. Demographic information, dose of BMP, tobacco use, outcomes, and complications were recorded. A total of 21 cases were included from four different studies meeting inclusion criteria.

Clinical Relevance The union rates were 90.5% overall, 100% for primary surgeries, and 77.8% for revision surgeries. Five patients (24%) experienced 11 complications, including four cases (19%) of heterotrophic ossification. Use of BMP in scaphoid nonunion surgery resulted in a 90.5% overall union rate but was also associated with complications such as heterotopic ossification. All included studies used BMP to augment bone graft, screw or wire fixation, or a combination of methods. The efficacy of BMP in scaphoid nonunion is unclear, and a sufficiently powered, randomized controlled trial is needed to determine optimal fixation methods, dosing, and morbidity of the use of BMP.

Level of Evidence This is a Level IC, therapeutic interventional study.

Keywords

scaphoid - scaphoid fracture - bone morphogenetic protein - scaphoid fixation - scaphoid nonunion

Note

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Army, Defense Health Agency, Department of Defense, or the US Government.


Ethical Approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation at the respective institutions of the cited articles and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the cited studies. This article does not contain any studies with animal subjects.




Publikationsverlauf

Eingereicht: 30. April 2020

Angenommen: 19. November 2020

Artikel online veröffentlicht:
23. Januar 2021

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