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The use of rhBMP-2 for the treatment of congenital pseudarthrosis of the tibia: a case series.

Congenital pseudarthrosis of the tibia is a rare disorder that is difficult to treat successfully. Despite varied initial clinical presentations, this condition results in a pathologic fracture in nearly all cases. Frequently, there is an accompanying fracture of the fibula. Both fractures are recalcitrant to standard treatment, and patients with this condition often require multiple surgical procedures in an effort to achieve fracture union and a functional extremity. Historically, many patients eventually have had painful low-functioning limbs or even amputation1-3.

Numerous treatment methods have been used to obtain and maintain healing of congenital pseudarthrosis of the tibia. Intramedullary fixation1,4,5, free vascularized fibular graft6,7, and Ilizarov bone transport8,9 have all been used, with union rates ranging from 14% to 86%1,2,4,8,9. The results of intramedullary fixation that were reported in two recent studies were encouraging. In a retrospective review in which the Charnley-Williams procedure was used, Johnston defined important variables of the technique that lead to more consistent union rates5. Concomitant fibular osteotomies, with or without fixation, yielded superior clinical and radiographic results compared with leaving the fibula intact. In addition, Dobbs et al. reported the long-term results for twenty-one consecutive patients who were managed with the Williams rod technique4. Union occurred in 86% of the patients, but healing took an extended period of time (average, sixteen months), and there was a 57% rate of refracture after a mean duration of follow-up of 14.2 years.

Recently, two types of recombinant human bone morphogenetic protein (rhBMP) have been approved for the clinical treatment of fractures in specific situations10,11. Multiple studies have demonstrated the safety and efficacy of rhBMPs …