Safety study: is there a pathologic IGF-1, PDGF and TGF-β cytokine expression caused by adjunct BMP-7 in tibial and femoral non-union therapy?

Figures & data

Figure 1 Perioperative X-rays of a femoral non-union.

Notes: Before non-union treatment according to the diamond concept (A) and 6 months postoperatively when consolidation was achieved (B). The intramedullary nail was removed, the non-union resected and the gap was filled with ABG (autologous bone graft), 3.3 mg BMP-7 and a tricalcium phosphate bone graft (Vitoss; Stryker, Duisburg, Germany). Re-osteosynthesis was performed with an angled blade plate.

Figure 2 Groups of matched patients: G1 – treatment with BMP-7 and autologous bone graft (ABG) according to the diamond concept, G2 – treatment with ABG alone.

Table 1 Characteristics of study patients who were matched into pairs

Code	Gender	Age (years)	Location	BMI (kg/m^2)	Smoker	Cotinine status	Procedure
G002	F	56	Tibia	29.06	NS	Neg	Diamond
G020	F	54	Tibia	23.43	FS	Neg	ABG
G019	M	41	Tibia	41.8	S	Pos	Diamond
268DKT	M	39	Tibia	25.7	S	Pos	ABG
G018	F	41	Tibia	40.1	NS	Neg	Diamond
261PC	F	24	Tibia	18	NS	Neg	ABG
G029	F	58	Tibia	27.11	NS	Neg	Diamond
263RJ	F	60	Tibia	29.23	NS	Neg	ABG
G024	F	65	Tibia	21.72	S	Pos	Diamond
259GK	F	70	Tibia	24.8	S	Pos	ABG
G005	M	52	Tibia	30.68	FS	Pos	Diamond
283DW	M	49	Tibia	22.2	S	Pos	ABG
G001	F	45	Femur	25.71	NS	Neg	Diamond
C017	F	46	Femur	27.06	FS	Neg	ABG
G003	M	46	Femur	32.87	NS	Neg	Diamond
279RP	M	69	Femur	39.5	NS	Neg	ABG
G012	F	57	Femur	21.48	S	Pos	Diamond
C008	F	41	Femur	21.55	FS	Pos	ABG
G008	F	27	Femur	20.32	S	Pos	Diamond
273JZ	F	42	Femur	24.2	S	Pos	ABG

Abbreviations: F, female; M, male; S, smoker; NS, non-smoker; FS, former smoker; ABG, autologous bone graft; Neg, negative; Pos, positive.

Figure 3 Timeline of sample acquisition according to a standardized cytokine protocol.

Figure 4 Analysis of sequential IGF-1 (A), PDGF-AB (B) and TGF-β (C) expression levels of G1 (autologous bone graft with additional BMP-7) and G2 (autologous bone graft alone) groups expressed as absolute mean concentrations ± standard deviation.

Notes: Serum concentration was measured in picograms per milliliter (pg/mL). The Wilcoxon’s signed-rank test assessed significant differences between both groups at each particular time point (*indicates significant differences, p<0.05).