Eight-Centimeter Segmental Ulnar Defect Treated With Recombinant Human Bone Morphogenetic Protein-2

Abstract not available. Introduction provided instead.

Management of segmental bone defects resulting from trauma can present the surgeon with an uncommon challenge because of the potential complications and poor prognosis associated with this type of injury. The impact on the patient is often significant and may result in permanent disability or loss of limb. Treatment recommendations for long-bone defects have included autogenous bone grafting, bone transport, acute bone shortening, and amputation.^1-5 The disadvantages of
using autograft bone include the blood loss associated with harvest and the morbidity at the iliac crest donor site.^6-8 For bone defects larger than 5 cm, historical options have included amputation, bone transport, and vascularized fibular transfers.^9-12 All these options have potentially significant morbidity associated with treatment. Donor-site morbidity of fibular graft site was reported in 19% of cases,13 and secondary fracture through fibular graft was reported in 23% of cases.¹⁴

Use of recombinant human bone morphogenetic proteins (rhBMPs) may be a viable alternative to autogenous bone grafting. With its significant osteoinductive effects,15,16 rhBMP-2 has already been found effective in bone formation in critical-size bone defects in multiple animal models.^17-20 Johnson and colleagues²¹ reported on use of human BMP extracts combined with autograft to treat 6 tibial segmental defects; all patients developed solid union, and mean time to union was 4.7 months.

Here we describe the off-label use of rhBMP-2 on a posttraumatic 8-cm bone defect in an ulna successfully treated with rhBMP-2/absorbable collagen sponge (ACS) along with calcium phosphate ceramic granules (Infuse®/MasterGraft, Medtronic Sofamor Danek, Memphis, Tenn).