The treatment of nonunions with application of BMP-7 increases the expression pattern for angiogenic and inflammable cytokines: a matched pair analysis

Figures & data

Table 1 Patient’s characteristics and demographics comparing the BMP-7 group to the control group

Patients	n	Sex		Age (years)	BMI (kg/m^2)	Smoking			Diabetes		Localization		Fixation
		Female	Male			S	FS	NS	Yes	No	Tibia	Femur	Nail	Plate
All patients	20	10	10	52.00±9.73	28.86±6.45a	7	4	9	0	20	8	12	9	11
Control group (G1)	10	5	5	52.50±10.1	26.94±5.65b	3	3	4	0	10	3	7	1	9
Intervention group (G2)	10	5	5	51.50±9.9	30.59±6.91	4	1	5	0	10	5	5	8	2

Notes: Age and BMI data presented as mean ± SD. Smoking is divided into three subgroups (S, FS, and NS).

a Indicates data from only 19 patients.

b Indicates data from only 9 patients.

Abbreviations: BMP-7, bone morphogenetic protein-7; BMI, body mass index; SD, standard deviation; S, smoker, FS, former smoker, NS, nonsmoker; G1, patients who were treated with transplantation of autologous bone graft; G2, patients who were treated with additional application of BMP-7.

Figure 1 A timeline of the protocol for taking blood samples throughout this study.

Notes: Blood was drained from each patient 1d p and 2d, 1w, 2w, 4w, 6w, and 12w after surgery.

Abbreviations: p, preoperative; d, day(s); w, week(s).

Figure 2 Evaluation of the expression pattern of VEGF after nonunion treatment.

Notes: (A) Serum concentrations of VEGF in pg/mL 1d before and 2d, 1w, 2w, 4w, 6w, and 12w after surgery. Significant differences are indicated by a star (P<0.05, whiskers are SD). (B) Box plot after 2d to 2w of surgery. Whiskers demonstrate one-quarter of the sample. Stars indicate significant differences comparing the study and control groups at the time point (P<0.05).

Abbreviations: VEGF, vascular endothelial growth factor; p, preoperative; d, day(s); w, week(s); SD, standard deviation; BMP-7, bone morphogenetic protein-7; G1, patients who were treated with transplantation of autologous bone graft; G2, patients who were treated with additional application of BMP-7.

Figure 3 Evaluation of the expression pattern of TNF-α and IL-8 after nonunion treatment.

Notes: (A) Serum concentrations of TNF-α in pg/mL 1d before and 2d, 1w, 2w, 4w, 6w, and 12w after surgery. (B) Serum concentrations of IL-8 in pg/mL 1d before and 2d, 1w, 2w, 4w, 6w, and 12w after surgery. Peak of IL-8 in the control group could be found after 4w of surgery. Peak of IL-8 in the study group was found within the first 2w after surgery.

Abbreviations: TNF-α, tumor necrosis factor-α; p, preoperative; d, day(s); w, week(s); SD, standard deviation; IL-8, interleukin-8; BMP-7, bone morphogenetic protein-7; G1, patients who were treated with transplantation of autologous bone graft; G2, patients who were treated with additional application of BMP-7.

Figure 4 Evaluation of the expression pattern of IL-6 after nonunion treatment.

Notes: (A) Serum concentrations of IL-6 in pg/mL 1d before and 2d, 1w, 2w, 4w, 6w, and 12w after surgery. Significant differences are indicated by a star (P<0.05, whiskers are SEM). (B) Box plot in a logarithmic scale on the y-axis of day before to 1w after surgery. Whiskers demonstrate one-quarter of the sample. Stars indicate significant differences comparing the study and control group at the time point (P<0.05).

Abbreviations: IL-6, interleukin-6; p, preoperative; d, day(s); w, week(s); SEM, standard error of the mean; BMP-7, bone morphogenetic protein-7; G1, patients who were treated with transplantation of autologous bone graft; G2, patients who were treated with additional application of BMP-7.

Figure 5 Analysis of the serological inflammable parameters after nonunion treatment.

Notes: (A) Serum concentrations of CRP in mg/L 1d before and 2d, 1w, and 2w after surgery. (B) Serum concentrations of leukocytes in l,000/nL 1d before and 2d, 1w, and 2w after surgery.

Abbreviations: CRP, C-reactive protein; p, preoperative; d, day(s); w, week(s); BMP-7, bone morphogenetic protein-7; G1, patients who were treated with transplantation of autologous bone graft; G2, patients who were treated with additional application of BMP-7.