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Case Report: L. Fabeck, D. Ghafil, M. Gerroudj, R. Baillon, and Ph. Delincé Bone morphogenetic protein 7 in the treatment of congenital pseudarthrosis of the tibia J Bone Joint Surg Br 2006; 88-B: 116-118 [Abstract] [Full text] [PDF]

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BMP-7 in the treatment of congenital pseudarthrosis of the tibia

Subir L. Bali, Constantinos Tilkeridis, Ilizarov Fellow   (8 March 2006)

BMP-7 in the treatment of congenital pseudarthrosis of the tibia 8 March 2006
Subir L. Bali, Senior House Officer Rowley Bristow Orthopaedic Centre,St.Peter's Hospital, Guildford Road, Chertsey,KT16 OPZ, UK, Constantinos Tilkeridis, Ilizarov Fellow Send letter to journal: Re: BMP-7 in the treatment of congenital pseudarthrosis of the tibia subirbali{at}doctors.org.uk Subir L. Bali, et al.	Sir, We read this case report with interest and would like to raise the following points. It would be impossible to conclude that BMP-7 was responsible for union in this recalcitrant case as autologous bone was concomitantly packed into the non-union site at the time of operation. Certainly BMP-7 was shown to be as effective as autogenic bone graft in a comparative trial for cases of tibial non-union,1 however, unless this is shown in the treatment of congenital pseudarthrosis in a similar fashion it will remain an unassessed expensive adjunct of indeterminate efficacy. The authors also described how the affected leg refractured repeatedly after removal of either the protective cast or the intramedullary rods. It is customary to maintain protection of the operated limb with an external brace until the medullary canal reforms.2 It is the practice in our institution to maintain the intramedullary rod fixation certainly up until skeletal maturity. The intramedullary device provides internal splinting for the maturing bone and we have found that refracture or recurrent bowing of the tibia can occur 3 upon its premature removal, leaving the affected limb unaccommodating to any further treatment. S.L.Bali, C.Tilkeridis, Rowley Bristow Orthopaedic Centre, St. Peter’s Hospital, Chertsey, UK. 1. Friedlander GE, Perry CR, Cole JD, et al. Osteogenic protein-1 (bone morphogenetic protein-7) in the treatment of tibial nonunions.J Bone Joint Surg [Am] 2001;83-A Suppl 1(Pt 2):S151-8. 2. Umber JS, Moss SW, Coleman SS. Surgical treatment of congenital pseudarthrosis of the tibia. Clin Orth Rel Res 1982;168:28-33. 3. Paterson DC, Simonis RB. Electrical stimulation in the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg [Br] 1985;67-B:454-62.