From the Department of Orthopedic Surgery, Walter Reed National Military Medical Center; and Department of Orthopedic Surgery, William Beaumont Army Medical Center.
Plast Reconstr Surg. 2022 Sep 1;150(3):608e-612e. doi: 10.1097/PRS.0000000000009416. Epub 2022 Jul 1.
Bone morphogenic protein-2 has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive bone morphogenic protein-2 to further characterize bone morphogenic protein-2 use in the hand and wrist.
Retrospective review of scaphoid fractures treated surgically in one region of the Military Health System from 2009 to 2019 was conducted to identify cases using bone morphogenic protein-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior nonunions, union rates at 4 and 6 weeks, and functional outcomes.
Fourteen patients met inclusion criteria. Nonunions accounted for 50 percent of included fractures. The total union rate was 93 percent. Mean time to union was 6.2 weeks. All acute fractures healed with a mean time to union of 4.8 weeks. Nonunions had a union rate of 86 percent, with a mean time to union of 7.7 weeks. Four patients (29 percent) developed radiographic heterotopic ossification; however, no significant decrease in motion was appreciated. Thirteen patients (93 percent) resumed the push-ups portion of the military fitness test. No major complications were identified during follow-up.
Adjunctive use of bone morphogenic protein-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess whether adjunctive bone morphogenic protein-2 use in scaphoid fractures provides significant benefit compared with other treatments.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
骨形态发生蛋白-2 在辅助治疗骨折方面显示出了潜力。其在上肢的应用报道有限。本研究报告了使用辅助性骨形态发生蛋白-2 治疗舟状骨骨折的愈合率、结果和并发症，以进一步描述骨形态发生蛋白-2 在手部和腕部的应用。
对一个军事医疗系统区域 2009 年至 2019 年接受手术治疗的舟状骨骨折病例进行回顾性研究，以确定使用骨形态发生蛋白-2 的病例。通过计算机断层扫描确定骨折愈合情况。主要结局包括愈合率、愈合时间和并发症。次要结局包括既往骨折不愈合的愈合率、4 周和 6 周时的愈合率以及功能结局。
14 名患者符合纳入标准。不愈合占纳入骨折的 50%。总的愈合率为 93%。平均愈合时间为 6.2 周。所有急性骨折的愈合时间平均为 4.8 周。不愈合的愈合率为 86%，平均愈合时间为 7.7 周。4 名患者（29%）出现放射状异位骨化；然而，运动功能没有明显下降。13 名患者（93%）恢复了军事体能测试中的俯卧撑部分。在随访期间未发现重大并发症。
在舟状骨骨折的手术固定中辅助使用骨形态发生蛋白-2 可获得理想的愈合率，且无重大并发症。需要更大的前瞻性研究来评估与其他治疗方法相比，辅助性骨形态发生蛋白-2 在舟状骨骨折中的应用是否具有显著益处。
