RhBMP7 use for treating scaphoid non-union: 5 cases assessed at 10 years’ follow-up

• Published in: Hand surgery and rehabilitation 2020-10, Vol.39 (5), p.383-388
• Main Authors: Chevet-Noël, A., Delord, M., Bertrand, D., Obert, L., Lepage, D., Pluvy, I., Loisel, F.
• Format: Article
• Language: English
• Subjects: Life Sciences; Non-union; Pseudarthrose; RhBMP7; Scaphoid; Scaphoïde
• ISSN: 2468-1229; 2468-1210
• DOI: 10.1016/j.hansur.2020.06.001

The scaphoid is the most common non-union site in the wrist. Fixation with vascularised or non-vascularised autograft is the gold standard when it comes to treating these non-unions. But, what can we offer if the autograft fails? Using osteoinductive proteins in difficult cases of long bone non-union yields good results. However, only a few studies have been published on their use for scaphoid non-union. In our study, five patients with an average age of 32 years (ranging from 21 to 44 years) with old non-union (more than 24 months) of the scaphoid were treated after autograft treatment had failed. The procedure consisted of reaming the non-union site, then adding bone autograft combined with BMP-7 (Osigraft®) in the defect and fixing it all with a screw or K-wire. Postoperative immobilisation was prescribed. Only one patient achieved bone union (20%) despite an average follow-up of 10 years (80–143 months). The average flexion-extension loss was 16.6° (0–30) relative to the contralateral side. The average strength deficit was 450 grams (0–2000) for pinch and 12.1kg (0–29) for grip compared to the contralateral side. Self-assessment questionnaires had an average PRWE at 28.9 (10.5–49) and an average QuickDASH at 28.6 (9.09–61.36). Our study could not demonstrate any real benefit of using BMP-7 for treating old scaphoid non-union despite an elevated cost. Further research is needed to look at other treatment approaches, for instance, the use of new scaffolds combining VEGF and BMP. La pseudarthrose du scaphoïde est la plus fréquente des pseudarthroses. Une fixation et une autogreffe vascularisée ou non demeurent les principes du traitement de référence de ces pseudarthroses. Mais, que proposer en cas d’échec de l’autogreffe? L’utilisation de protéines ostéoinductives dans des cas difficiles de traitement des pseudarthroses des os longs ont montré de bons résultats ; cependant, peu d’études ont été réalisées quant à leur utilisation pour les pseudarthroses du scaphoïde. Cinq patients d’âge moyen 32 ans (21–44) présentant une pseudarthrose ancienne (supérieure à 24 mois) du scaphoïde ont été pris en charge après un échec d’autogreffe. L’intervention consistait en un avivement du foyer de pseudarthrose. Une autogreffe osseuse associée à de la RhBMP-7 (Osigraft®) était mise en place et fixée par vis ou broche. Une immobilisation postopératoire était prescrite. Un seul patient a pu consolider (20%) avec un recul moyen de 10 ans (80–143 mois). La perte moyenne du