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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
› Author Affiliations 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.




Publication History

Received: 30 April 2020

Accepted: 19 November 2020

Article published online:
23 January 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Hove LM. Epidemiology of scaphoid fractures in Bergen, Norway. Scand J Plast Reconstr Surg Hand Surg 1999; 33 (04) 423-426
    CrossrefPubMedGoogle Scholar
  • 2 Merrell GA, Wolfe SW, Slade III JF. Treatment of scaphoid nonunions: quantitative meta-analysis of the literature. J Hand Surg Am 2002; 27 (04) 685-691
    CrossrefPubMedGoogle Scholar
  • 3 Pinder RM, Brkljac M, Rix L, Muir L, Brewster M. Treatment of scaphoid nonunion: a systematic review of the existing evidence. J Hand Surg Am 2015; 40 (09) 1797-1805.e3
    CrossrefPubMedGoogle Scholar
  • 4 Grewal R, Suh N, Macdermid JC. Use of computed tomography to predict union and time to union in acute scaphoid fractures treated nonoperatively. J Hand Surg Am 2013; 38 (05) 872-877
    CrossrefPubMedGoogle Scholar
  • 5 Chang MA, Bishop AT, Moran SL, Shin AY. The outcomes and complications of 1,2-intercompartmental supraretinacular artery pedicled vascularized bone grafting of scaphoid nonunions. J Hand Surg Am 2006; 31 (03) 387-396
    CrossrefPubMedGoogle Scholar
  • 6 Rancy SK, Swanstrom MM, DiCarlo EF, Sneag DB, Lee SK, Wolfe SW. Scaphoid Nonunion Consortium. Success of scaphoid nonunion surgery is independent of proximal pole vascularity. J Hand Surg Eur Vol 2018; 43 (01) 32-40
    CrossrefPubMedGoogle Scholar
  • 7 Higgins JP, Burger HK. Proximal scaphoid arthroplasty using the medial femoral trochlea flap. J Wrist Surg 2013; 2 (03) 228-233
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Doi K, Oda T, Soo-Heong T, Nanda V. Free vascularized bone graft for nonunion of the scaphoid. J Hand Surg Am 2000; 25 (03) 507-519
    CrossrefPubMedGoogle Scholar
  • 9 Caporrino FA, Dos Santos JB, Penteado FT, de Moraes VY, Belloti JC, Faloppa F. Dorsal vascularized grafting for scaphoid nonunion: a comparison of two surgical techniques. J Orthop Trauma 2014; 28 (03) e44-e48
    CrossrefPubMedGoogle Scholar
  • 10 Loeffler BJ, Kellam JF, Sims SH, Bosse MJ. Prospective observational study of donor-site morbidity following anterior iliac crest bone-grafting in orthopaedic trauma reconstruction patients. J Bone Joint Surg Am 2012; 94 (18) 1649-1654
    CrossrefPubMedGoogle Scholar
  • 11 Kim DH, Rhim R, Li L. et al. Prospective study of iliac crest bone graft harvest site pain and morbidity. Spine J 2009; 9 (11) 886-892
    CrossrefPubMedGoogle Scholar
  • 12 Patel JC, Watson K, Joseph E, Garcia J, Wollstein R. Long-term complications of distal radius bone grafts. J Hand Surg Am 2003; 28 (05) 784-788
    CrossrefPubMedGoogle Scholar
  • 13 Malizos KN, Dailiana Z, Varitimidis S, Koutalos A. Management of scaphoid nonunions with vascularized bone grafts from the distal radius: mid- to long-term follow-up. Eur J Orthop Surg Traumatol 2017; 27 (01) 33-39
    CrossrefPubMedGoogle Scholar
  • 14 Tsantes AG, Papadopoulos DV, Gelalis ID, Vekris MD, Pakos EE, Korompilias AV. The efficacy of vascularized bone grafts in the treatment of scaphoid nonunions and Kienbock disease: a systematic review in 917 patients. J Hand Microsurg 2019; 11 (01) 6-13
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Urist MR. Bone: formation by autoinduction. Science 1965; 150 (3698): 893-899
    CrossrefPubMedGoogle Scholar
  • 16 Even J, Eskander M, Kang J. Bone morphogenetic protein in spine surgery: current and future uses. J Am Acad Orthop Surg 2012; 20 (09) 547-552
    CrossrefPubMedGoogle Scholar
  • 17 Ong KL, Villarraga ML, Lau E, Carreon LY, Kurtz SM, Glassman SD. Off-label use of bone morphogenetic proteins in the United States using administrative data. Spine 2010; 35 (19) 1794-1800
    CrossrefPubMedGoogle Scholar
  • 18 Swiontkowski MF, Aro HT, Donell S. et al. Recombinant human bone morphogenetic protein-2 in open tibial fractures. A subgroup analysis of data combined from two prospective randomized studies. J Bone Joint Surg Am 2006; 88 (06) 1258-1265
    CrossrefPubMedGoogle Scholar
  • 19 Dai J, Li L, Jiang C, Wang C, Chen H, Chai Y. Bone morphogenetic protein for the healing of tibial fracture: a meta-analysis of randomized controlled trials. PLoS One 2015; 10 (10) e0141670
    CrossrefPubMedGoogle Scholar
  • 20 Kujala S, Raatikainen T, Ryhänen J, Kaarela O, Jalovaara P. Composite implant of native bovine bone morphogenetic protein (BMP) and biocoral in the treatment of scaphoid nonunions--a preliminary study. Scand J Surg 2002; 91 (02) 186-190
    CrossrefPubMedGoogle Scholar
  • 21 Jones NF, Brown EE, Mostofi A, Vogelin E, Urist MR. Healing of a scaphoid nonunion using human bone morphogenetic protein. J Hand Surg Am 2005; 30 (03) 528-533
    CrossrefPubMedGoogle Scholar
  • 22 Bilic R, Simic P, Jelic M. et al. Osteogenic protein-1 (BMP-7) accelerates healing of scaphoid non-union with proximal pole sclerosis. Int Orthop 2006; 30 (02) 128-134
    CrossrefPubMedGoogle Scholar
  • 23 Ablove RH, Abrams SS. The use of BMP-2 and screw exchange in the treatment of scaphoid fracture non-union. Hand Surg 2015; 20 (01) 167-171
    CrossrefPubMedGoogle Scholar
  • 24 Brannan PS, Gaston RG, Loeffler BJ, Lewis DR. Complications with the use of BMP-2 in scaphoid nonunion surgery. J Hand Surg Am 2016; 41 (05) 602-608
    CrossrefPubMedGoogle Scholar
  • 25 Rice I, Lubahn JD. Use of bone morphogenetic protein-2 (rh-BMP-2) in treatment of wrist and hand nonunion with comparison to historical control groups. J Surg Orthop Adv 2013; 22 (04) 256-262
    CrossrefPubMedGoogle Scholar
  • 26 Liberati A, Altman DG, Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
    CrossrefPubMedGoogle Scholar
  • 27 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
    CrossrefPubMedGoogle Scholar
  • 28 Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
    CrossrefPubMedGoogle Scholar
  • 29 Steinmann SP, Adams JE. Scaphoid fractures and nonunions: diagnosis and treatment. J Orthop Sci 2006; 11 (04) 424-431
    CrossrefPubMedGoogle Scholar
  • 30 Waitayawinyu T, McCallister WV, Nemechek NM, Trumble TE. Scaphoid nonunion. J Am Acad Orthop Surg 2007; 15 (05) 308-320
    CrossrefPubMedGoogle Scholar
  • 31 Werdin F, Jaminet P, Naegele B, Pfau M, Schaller HE. Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius. Eplasty 2014; 14: e24
    PubMedGoogle Scholar
  • 32 Mahmoud M, Koptan W. Percutaneous screw fixation without bone grafting for established scaphoid nonunion with substantial bone loss. J Bone Joint Surg Br 2011; 93 (07) 932-936
    CrossrefPubMedGoogle Scholar