Notwendigkeit von "bone morphogenetic proteins" in der Frakturbehandlung

Abstract

Bone morphogenetic proteins (BMP) are bone growth factors. They are released locally following a fracture event and stimulate the healing process right through to bone remodelling. Since 2001 it has been possible to use BMP2 and BMP7 as medications for genetic engineering; BMP2 is indicated for open fractures of the lower leg and BMP7, for nonunion in the tibia. Delayed fracture healing and nonunion are common, being observed in up to 10% of all cases (up to 30% in risk groups). Quite apart from the personal, sometimes disastrous, consequences for the individual patient, they also represent a considerable loss to the national economy. The conventional treatments for nonunion (including autologous and allogeneic bone transplantation, dynamisation of the nail or a strained plate fixation) are not always successful. The success rate of initial cancellous bone transplantation in the lower leg for delayed fracture healing is only 60-70%. In our patient population (26 tibial fractures treated with BMP7; average of 3 previous operations) healing was achieved with no further surgery in 89% of cases. In view of the high economic costs of delayed healing and the decidedly higher success rate of BMP implantation, this medication should be used at an early stage despite its high cost. © Springer Medizin Verlag 2006.