Following Urist’s original isolation of Bone Morphogenetic Protein (BMP), several recombinant proteins of the Bone Morphogenetic Protein-Osteogenic Protein family have been produced including rhBMP-2, rhBMP-4 and OP-1 (BMP-7) and shown experimentally to induce bone formation in rat, rabbit, sheep and primate models. Partially purified human bone morphogenetic protein (hBMP) has been used clinically in femoral and tibial non-unions and spinal fusions. This is the first study to describe the use of hBMP and rhBMP in hand surgery as an adjunct in the treatment of scaphoid non-unions, Kienbock’s disease and non-unions of the forearm and hand.

Methods: 7 patients have undergone implantation of 50 –100mg hBMP or rhBMP-7, for proximal pole scaphoid non-unions (2), Kienbock’s disease (3) and non-unions (2). One scaphoid non-union underwent K-wire fixation and implantation of hBMP, whereas, the second underwent cortico-cancellous bone grafting and implantation of hBMP. One patient with Kienbock’s disease underwent first dorsal metacarpal artery revascularization, cancellous bone grafting and implantation of hBMP; whereas the other 2 patients underwent vascularized bone grafting and implantation of hBMP. One patient with a chronic non-union of the ulna underwent cortico-cancellous bone grafting, compression plate fixation and implantation of 100 mg of hBMP. One patient with a non-union of a previous bone graft of the thumb metacarpal and proximal phalanx underwent compression plating and implantation of OP-1 (rhBMP-7).

Results: Follow-up ranged from 2 – 6 years. Both patients with scaphoid non-unions had complete relief of their pain and radiographic evidence of healing. Two patients with Kienbock’s disease had complete relief of their pain, whereas the third patient had good relief of his pain. Serial X-rays revealed no further progression in lunate collapse. MRI scans in all 3 patients showed islands of increasing vascularity but not complete revascularization of the lunate. Follow-up X-rays of the two non-unions showed increasing consolidation of the bone grafted segment.

Conclusions: This is the first preliminary report on the use of partially purified human BMP and pure recombinant human BMP to augment the bony healing of scaphoid non-unions, Kienbock’s disease and non-unions in the upper extremity. It is obviously impossible to prove that BMP was responsible for the bony healing seen in these patients since other conventional techniques such as cancellous bone grafting, vascularized bone grafting and compression plate fixation were also used. However, it is likely that BMP will have increasing clinical applications in hand surgery in the future.