Utilidad de la proteína morfogenética en el tratamiento de la seudoartrosis congénita de la tibia

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Abstract

Objetivo: Reportar la capacidad de la proteína morfogenética de lograr la consolidación ósea en pacientes con seudoartrosis congénita de tibia. Pacientes y métodos: Se realizó en tres pacientes con diagnóstico de seudoartrosis congénita de tibia, se hizo seguimiento durante seis meses a cada uno observando la consolidación y capacidad funcional de la extremidad. Resultados: Se logró consolidación en todos los casos presentándose ésta a los tres meses y medio en promedio. Conclusiones: La proteína morfogenética tiene utilidad como coadyuvante para conseguir la regeneración y consolidación ósea en pacientes con seudoartrosis congénita de tibia.

Translated abstract

Objective: To report the ability of bone morphogenetic protein to achieve bone healing in patients with congenital pseudoarthrosis of the tibia. Patients and methods: Three patients with a diagnosis of congenital pseudoarthrosis of the tibia were followed-up for six months. Bone healing and functional capacity of the limb were observed. Results: Bone healing occurred in all cases at a mean of three and half months of treatment. Conclusions: Morphogenetic protein is useful as an adjuvant to achieve bone regeneration and healing in patients with congenital pseudoarthrosis of the tibia.

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Most cited references 25

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Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions.

Bruce Cook, William Calhoun, A LaForte … (2000)

The role of bone morphogenetic proteins (BMPs) in osseous repair has been demonstrated in numerous animal models. Recombinant human osteogenic protein-1 (rhOP-1 or BMP-7) has now been produced and was evaluated in a clinical trial conducted under a Food and Drug Administration approved Investigational Device Exemption to establish both the safety and efficacy of this BMP in the treatment of tibial nonunions. The study also compared the clinical and radiographic results with this osteogenic molecule and those achieved with fresh autogenous bone. One hundred and twenty-two patients (with 124 tibial nonunions) were enrolled in a controlled, prospective, randomized, partially blinded, multi-center clinical trial between February, 1992, and August, 1996, and were followed at frequent intervals over 24 months. Each patient was treated by insertion of an intramedullary rod, accompanied by rhOP-1 in a type I collagen carrier or by fresh bone autograft. Assessment criteria included the severity of pain at the fracture site, the ability to walk with full weight-bearing, the need for surgical re-treatment of the nonunion during the course of this study, plain radiographic evaluation of healing, and physician satisfaction with the clinical course. In addition, adverse events were recorded, and sera were screened for antibodies to OP-1 and type-I collagen at each outpatient visit. At 9 months following the operative procedures (the primary end-point of this study), 81% of the OP-1-treated nonunions (n = 63) and 85% of those receiving autogenous bone (n = 61) were judged by clinical criteria to have been treated successfully (p = 0.524). By radiographic criteria, at this same time point, 75% of those in the OP-1-treated group and 84% of the autograft-treated patients had healed fractures (p = 0.218). These clinical results continued at similar levels of success throughout 2 years of observation, and there was no statistically significant difference in outcome between the two groups of patients at this point (p = 0.939). All patients experienced adverse events. Forty-four percent of patients in each treatment group had serious events, none of which were related to their bone grafts. More than 20% of patients treated with autografts had chronic donor site pain following the procedure. rhOP-1 (BMP-7), implanted with a type I collagen carrier, was a safe and effective treatment for tibial nonunions. This molecule provided clinical and radiographic results comparable with those achieved with bone autograft, without donor site morbidity.

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Pathology and natural history of congenital pseudarthrosis of the tibia.

John Boyd (1982)

Of the six types of congenital pseudarthrosis, Type II is the most common and lends to poorest prognosis. The basic pathology is an aggressive osteolytic fibromatosis. Failures in these patients are due to recurrence of the osteolytic fibromatosis, which can remove living bone or a dead bone graft. Type III cases have a better prognosis. The gross pathology is a bone cyst, and the microscopic findings resemble fibrous dysplasia. After surgical treatment, generally, the older the child the better the prognosis. Recurrences are rare after skeletal maturity.

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Congenital pseudarthrosis of the tibia: results of technical variations in the charnley-williams procedure.

E. Anna Johnston (2002)

Results of the Charnley-Williams method of intramedullary fixation for treatment of congenital pseudarthrosis of the tibia have varied, in part because of variations in surgical technique. The outcomes of three variations of this procedure were compared to determine which technique was the most likely to result in union. The results in twenty-three consecutive patients with congenital pseudarthrosis of the tibia were reviewed at four to fourteen years following initial surgical treatment with an intramedullary rod. Three types of procedures were performed: type A, which consisted of resection of the tibial pseudarthrosis with shortening, insertion of an intramedullary rod into the tibia, and tibial bone-grafting combined with fibular resection or osteotomy and insertion of an intramedullary rod into the fibula; type B, which was identical to type A except that it did not include fibular fixation; and type C, which consisted of insertion of a tibial rod and bone-grafting but no fibular surgery. The outcome was classified as grade 1 when there was unequivocal union with full weight-bearing function and maintenance of alignment requiring no additional surgical treatment; grade 2 when there was equivocal union with useful function, with the limb protected by a brace, and/or valgus or sagittal bowing for which additional surgery was required or anticipated; and grade 3 when there was persistent nonunion or refracture, requiring full-time external support for pain and/or instability. Eleven patients (48%) ultimately had a grade-1 outcome; nine, a grade-2 outcome; and three, a grade-3 outcome. The final outcome was not associated with either the initial radiographic appearance of the lesion or the age of the patient at the time of the initial surgery. The results following type-A and B operations were better than those after type-C procedures. Surgery on an intact fibula resulted in a lower prevalence of grade-3 outcomes than was found when an intact fibula was not operated on (p = 0.05). Transfixation of the ankle joint by the intramedullary rod did not decrease the prevalence of grade-3 outcomes. There is little justification for a type-C operation, as it either resulted in a persistent nonunion or failed to improve an equivocal outcome in every case. Leaving an intact fibula undisturbed to maintain stability or length also was not successful in this series. In addition, the presence of fibular insufficiency (fracture or a pre-pseudarthrotic lesion) was highly prognostic for subsequent valgus deformity (occurring in ten of twelve cases), whether or not the fibula eventually healed.

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Author and article information

Contributors

CR Soria-Sánchez: Role: ND

A López-Durán: Role: ND

A Isunza-Ramírez: Role: ND

Journal

Journal ID (publisher): aom

Title: Acta ortopédica mexicana

Abbreviated Title: Acta ortop. mex

Publisher: Colegio Mexicano de Ortopedia y Traumatología A.C.

ISSN: 2306-4102

Publication date (Print): June 2015

Volume: 29

Issue: 3

Pages: 182-185

Affiliations

[1 ] Instituto Nacional de Pediatría México

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Publisher ID: S2306-41022015000300008

SO-VID: 824c3a2a-0f7b-4676-85f6-99ba9994c3f6

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http://creativecommons.org/licenses/by/4.0/

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SciELO Mexico

Self URI (journal page): http://www.scielo.org.mx/scielo.php?script=sci_serial&pid=2306-4102&lng=en

Utilidad de la proteína morfogenética en el tratamiento de la seudoartrosis congénita de la tibia Translated title: Utility of morphogenetic protein for the treatment of congenital pseudoarthrosis of the tibia

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Most cited references 25

Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions.

Pathology and natural history of congenital pseudarthrosis of the tibia.

Congenital pseudarthrosis of the tibia: results of technical variations in the charnley-williams procedure.

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