An Audit of the effect of Bone Morphogenetic Protein-2 Treatment in patients with non-union of long bone fractures.

OBJECTIVE: To evaluate the outcomes, clinical and radiological application of Bone Morphogenetic Protein-2 alone versus Bone Morphogenetic Protein-2 with autograft in long bone non-unions. METHODS: A prospective review of patients was done with fracture non-union admitted to Aga Khan University Hospital, Karachi, from January 2016 to January 2019. The patients were divided into two groups; those exposed to Bone Morphogenetic Protein-2 alone in group 1, and those exposed to Bone Morphogenetic Protein-2 plus autologous graft in group 2. RESULTS: Background characteristics of both the groups were analysed. Patients were followed up at 6, 12 and 24 weeks through their medical records. The primary outcome was postoperative union at 6, 12 and 24. Union was defined by having the clinical union as well as the radiological union at the same time of assessment. Of the 80 patients enrolled, 13(16.25%) were excluded, and 5(6.25%) were lost to follow-up. The final sample had 62(77.5%) patients; 35(56.5%) in group 1, and 27(43.5%) in group 2. Union at 6 weeks was observed in 13(21%) patients; 8(62%) in group 1, and 5(38%) in group 2. Union at 12 weeks was observed in 38(61%) patients; 20(53%) in group 1, and 18(47%) in group 2. CONCLUSIONS: Results showed that using the adjuvant treatment alone was not worse than using it along with bone autologous graft.

Research progress in immunoregulation mechanism of bone trauma microenvironment / 中华创伤杂志

Trauma induces immune cells to infiltrate the fracture site, and regulates the removal of local dead bone and remodeling of new bone by secreting a variety of cytokines and inflammatory mediators. With the development of trauma immunology, the role of the immune system in the process of bone wound healing has been deeply studied in recent years. When fracture occurs, the non-specific and specific immune cells are successively attracted into the fracture site, participating in bone repair. If there was a disorder in the bone trauma microenvironment, the coordination between osteoblasts and osteoclasts will be disordered, leading to delayed or nonunion of fractures. Therefore, it is very important to systematically explore the communication between immune cells and immune cells or osteoblasts/osteoclasts in bone trauma microenvironment. The authors review the immune regulation mechanism in the process of bone clearance and repair after bone trauma, and provide a rationale for the future immunotherapy of bone trauma.