Recombinant human bone morphogenetic protein-2 for grade III open segmental tibial fractures from combat injuries in Iraq.

Autores:	T R Kuklo, A T Groth, R C Anderson, H M Frisch, R B Islinger
Idioma:	Eng.
Fecha:	2008-08-01
Revista:	The Journal of bone and joint surgery. British volume (0301-620X)
Entrega:	J Bone Joint Surg Br. 2008 Aug;90(8):1068-72
Abstract:	This is a retrospective consecutive case series of 138 Gustillo-Anderson type IIIB and IIIC segmental tibial fractures treated at Walter Reed Army Medical Center in soldiers injured in Iraq between March 2003 and March 2005. Five patients with a head injury and four who were lost to follow-up were excluded. The patients were treated definitively with either a ringed external fixator or a reamed intramedullary nail, evaluated in terms of supplementary bone grafting with either autogenous bone (group 1, 67 patients) or recombinant human bone morphogenetic protein-2 at 1.50 mg/ml applied to an absorbable collagen sponge (group 2, 62 patients). The mechanism of injury, defect size and classification, associated injuries, presence of infection, preliminary treatment/fixation, number of procedures before definitive management, time to and details of definitive management, subsequent infection, re-operation, smoking history and other complications were noted. Radiographs were assessed for union, delayed union or nonunion by an independent investigator. All the patients were male. Their mean age was 26.6 years (20 to 42) and the mean follow-up was for 15.6 months (12 to 32). Group 2 had a slightly higher profile of concomitant injuries and a slightly worse fracture classification, but these were not significant. The rate of union was 76% (51 of 67) for group 1 and 92% for group 2 (57 of 62; p = 0.015). There was also a higher rate of subsequent infection in group 1 (14.9%) compared with group 2 (3.2%; p = 0.001) and a higher rate of re-operation (28%) in group 1 (p = 0.003). There were no observed hypersensitivity reactions to the recombinant human bone morphogenetic protein-2 implant.
Copyright:	The Journal of bone and joint surgery. British volume Washington University School of Medicine, 660 S. Euclid, St. Louis, Missouri 63110, USA. kuklot wustl.edu
Full text:	DOI - The Journal of bone and joint surgery. British volume (DOI) EBSCO - HTML (con suscripción) HighWire Press - HTML (con suscripción) Ovid Technologies, Inc. - HTML (con suscripción) ProQuest Information and Learning - HTML (con suscripción)
Temas:	Adulto, Proteinas Morfogeneticas De Hueso, Trasplantacion Osea, Estudios De Seguimiento, Fijacion De Fractura, Fracturas Expuestas, Humanos, Iraq War, 2003 -, Varón, Personal Militar, Proteinas Recombinantes, Estudios Retrospectivos, Statistics as Topic, Fracturas De La Tibia, Factor Beta Transformador De Crecimiento, Trasplantacion Autologa, Resultado Del Tratamiento, Estados Unidos