Table 3.
Clinical studies on the application of BMP-7, ABG, or their combination for the treatment of long-bone fracture nonunions
| Study (year) | Type of study, LOE | Anatomic site of nonunions | Number of cases | Age (years)* | Time from injury (months)* | Number of previous operations* | Union rates | Time to nonunion healing (months)* | Reoperations |
|---|---|---|---|---|---|---|---|---|---|
| Souter [42] (1969) | Retrospective observational (ABG), IV | Tibia, femur, humerus, forearm | 102 ABG | 40 (15–77) | 6 (2–84) | NA | 86% | 4 | NA |
| Friedlaender et al. [18] (2001) | Prospective randomized, controlled (BMP-7 versus ABG), II | Tibia | 63 BMP-7 | Median 38 ± 16 | Median 27 ± 26 | NA | 81% | 9 | 5% |
| 61 ABG | Median 34 ± 14 | Median 33 ± 46 | 85% | 10% | |||||
| Babhulkar and Pande [3] (2005) | Retrospective observational (ABG), IV | Tibia, femur, humerus, forearm atrophic | 52 ABG | NA | NA | NA | 77% | 6 (4–8) | NA |
| Ronga et al. [38] (2006) | Retrospective observational (BMP-7), IV | Tibia, femur, humerus | 38 BMP-7 | 42.2 (15–78) | 27.3 ± 39.9 | 1.6 ± 0.8 | 86% | 7.9 (2–21) | 15.2% |
| 50 BMP-7 + ABG | 31.2 ± 59.0 | 2.7 ± 2.1 | 86.8% | ||||||
| Calori et al. [9] (2006) | Prospective randomized, controlled (BMP-7 versus PRP), II–III | Tibia, femur, humerus, forearm | 16 BMP-7 | 47.4 ± 2.56 | 15.2 ± 2.46 | 2.5 ± 0.57 | 94% | Radiographic 8 ± 0.43 | 6.2% |
| Zimmermann et al. [55] (2007) | Prospective comparative (BMP-7 versus ABG), III | Tibia | 18 BMP-7 | 44 (19–68) | 11 (NA) | 4 (NA) | 94.5% | 5 | 5.5% |
| 8 BMP-7 + ABG | 87.5% | 12.5% | |||||||
| 82 ABG | 0 | 72% | 31.7% | ||||||
| Kanakaris et al. [27] (2008) | Prospective observational (BMP-7), IV | Tibia | 43 BMP-7 | 42.6 (19–78) | 23 (9–317) | 2 (0–11) | 89.7% | 6.5 (3–15) | 6% |
| 25 BMP-7 + ABG | |||||||||
| Giannoudis et al. [current study] | Prospective observational (BMP-7 + ABG), IV | Tibia, femur, humerus | 45 BMP-7 + ABG | Median 43 (19–76) | Median 30 (6–312) | Median 2 (1–7) | 100% | Median 6 (4–16) | 0% |
* Values are expressed as mean (or median as noted) ± standard deviation with range in parentheses; BMP-7 = bone morphogenetic protein-7; ABG = autologous bone graft; LOE = level of evidence; NA = not available.