Treatment of Congenital Pseudarthrosis of the Tibia with Recombinant Human Bone Morphogenetic Protein-7 (rhBMP-7): A Report of Five Cases

Congenital pseudarthrosis of the tibia is one of the most conditions encountered in pediatric orthopaedics of the difficulty in achieving healing. treatment options have been explored with varying of success1-19. Although some reports have demonstrated healing7,9,19, it is very difficult to restore the structural and functional integrity of the bone such as which occurs after treatment of other types of fractures in . Advances in molecular biology have provided a better of the mechanisms of fracture-healing as well possible new solutions for the problem, including the use bone morphogenetic protein (BMP)20-24. In a controlled, , randomized study of 124 tibial nonunions (in 122 adult patients) treated with insertion of an intramedullary and recombinant human (rh) BMP-7, no significant (p = 0.939) was noted between the BMP group the group that received an intramedullary rod and autogenous crest bone grafts20. In a prospective, randomized, , single-blind study of 450 patients with an tibial fracture, patients who were treated with rhBMP- 2 (1.50 mg/mL) had significantly (p = 0.005) superior results with patients who were treated with intramedullary fixation and routine soft-tissue management as dictated the injury21. These two large clinical series suggest BMPs may be a good alternative to autogenous iliaccrest -grafting. morphogenetic proteins have shown promising in experimental animal models, and their clinical efficacy been shown in the treatment of adult tibial nonunions in spinal fusion20-24. They have not been tested in because of uncertainty as to the effect on adjacent and because of concern about unexpected reactions. use of BMP to treat congenital pseudarthrosis of the tibia a logical approach because the results from both animal and human trials have suggested that BMP is efficacious bone-healing. This prospective study was undertaken determine the clinical efficacy and safety of the use of -7 for the treatment of congenital pseudarthrosis of the in skeletally immature patients and to compare the results those of previously published studies in which autogenous -crest bone grafts have been used in conjunction various fixation methods.