Bone Morphogenic Protein-2 Use for the Surgical Treatment of Acute Scaphoid Fractures and Scaphoid Nonunions.

Background: Bone morphogenic protein-2 has demonstrated promise as an adjunct to surgically treating fractures. Its reported use in the upper extremity is limited. This study reports union rates, outcomes, and complications of scaphoid fractures treated with adjunctive bone morphogenic protein-2 to further characterize bone morphogenic protein-2 use in the hand and wrist.

Methods: Retrospective review of scaphoid fractures treated surgically in one region of the Military Health System from 2009 to 2019 was conducted to identify cases using bone morphogenic protein-2. Fracture healing was determined by computed tomography. Primary outcomes were union rate, time to union, and complications. Secondary outcomes included union rates for prior nonunions, union rates at 4 and 6 weeks, and functional outcomes.

Results: Fourteen patients met inclusion criteria. Nonunions accounted for 50 percent of included fractures. The total union rate was 93 percent. Mean time to union was 6.2 weeks. All acute fractures healed with a mean time to union of 4.8 weeks. Nonunions had a union rate of 86 percent, with a mean time to union of 7.7 weeks. Four patients (29 percent) developed radiographic heterotopic ossification; however, no significant decrease in motion was appreciated. Thirteen patients (93 percent) resumed the push-ups portion of the military fitness test. No major complications were identified during follow-up.

Conclusions: Adjunctive use of bone morphogenic protein-2 in operative fixation of scaphoid fractures resulted in desirable union rates without major complications. Larger, prospective studies are needed to assess whether adjunctive bone morphogenic protein-2 use in scaphoid fractures provides significant benefit compared with other treatments.

Clinical Question/level Of Evidence: Therapeutic, IV.