Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Clinical Application of Recombinant Human Bone Morphogenetic Protein-2 for Delayed Fractures in Dogs

개에서 골절의 지연유합에 대한 rhBMP-2의 임상적 적용 2례

  • Kim, Jae-Kyong (College of Veterinary Medicine, Chonnam National University) ;
  • Kim, Se-Eun (College of Veterinary Medicine, Chonnam National University) ;
  • Go, A-Ra (College of Veterinary Medicine, Chonnam National University) ;
  • Kim, Seung-Hyun (College of Veterinary Medicine, Chonnam National University) ;
  • Shim, Kyung-Mi (College of Veterinary Medicine, Chonnam National University) ;
  • Bae, Chun-Sik (College of Veterinary Medicine, Chonnam National University) ;
  • Choi, Seok-Hwa (College of Veterinary Medicine, Chungbuk National University) ;
  • Kang, Seong-Soo (College of Veterinary Medicine, Chonnam National University)
  • Accepted : 2012.10.12
  • Published : 2012.10.31
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Abstract

A 1-year-old, castrated male Yorkshire terrier (case 1) and a 7-year-old female Poodle (case 2) presented with delayed union fractures. In case 1, the dog had a fractured right distal radius and ulna. In case 2, the dog had a fractured left distal tibia and fibula. A physical examination and radiographs performed in both dogs revealed delayed union fractures with large gaps. The fracture sites were fixed by bone plate and screws. Autogenous cancellous bone graft was applied into the fracture gap. To encourage rapid bone union, we used matrigel containing $20{\mu}g$ of recombinant human bone morphogenetic protein-2 (rhBMP-2) in the fracture site. Radiographs were taken postoperatively to monitor healing. Rapid bone union was noted in both dogs in long-term radiographs. In case 1, the radiographs revealed that the fracture gaps of the radius and ulna were bridged at 2 weeks. Fracture lines were not observed and normal appearance was restored at 20 weeks. In case 2, the radiographs showed that fracture repair had progressed at 11 weeks. The fractures healed faster than expected in these two cases. The results indicate that rhBMP-2 and matrigel may be effective and useful materials to enhance healing of delayed fractures.

1년령의 중성화된 수컷 요크셔테리어와 7년령의 암컷 푸들이 골절의 지연유합으로 내원하였다. 요크셔테리어의 경우 오른쪽 요골과 척골의 원위부가 골절되었고, 푸들의 경우 왼쪽 경골과 비골의 원위부가 골절되었다. 두 환자에서 신체검사 및 방사선검사를 통해 골절의 유합이 지연되고 있음을 확인하였다. 골절부는 금속판 및 나사못으로 고정시키고 자가해면질골을 골절 틈새에 이식하였다. 또한 빠른 골유합을 위해 $20{\mu}g$의 rh-BMP 2 가 포함된 matrigel을 골절부에 주입하였다. 수술 후 방사선검사를 통해 골절부의 치유 상태를 확인하였다. 장기간의 방사선검사에서 두 마리 모두 빠른 골유합을 보였다. 첫 증례에서는 방사선사진상에서 2주째에 요골과 척골 골절 틈새에 골밀도가 증가하였다. 20주째에는 골절선이 더 이상 관찰되지 않았으며, 정상 외관을 회복하였다. 두 번째 증례에서는 방사선사진상에서 11주째에 골절 치유가 진행되고 있음이 확인되었다. 이 두 증례 모두 예상한 것보다 골절의 치유가 빠르게 일어났다. 따라서 rh-BMP 2와 matrigel은 지연유합된 골절의 치유를 촉진하는데 효과가 있다고 생각된다.

Keywords

References

  1. Baltzer AWA, Ostapczuk MS, Stosch D, Granrath M. The use of recombinant human bone morphogenetic protein-2 for the treatment of a delayed union following femoral neck openwedge osteotomy. Orthop Rev 2012; 4: e4: 17-19. https://doi.org/10.4081/or.2012.e17
  2. Copuroglu C, Ercan S, Ozcan M, Ciftdemir M, Turan FN, Yalniz E. Comparision of autogenous bone graft donor site haemostatic agents used in spinal surgery. Acta Orthop Traumatol Turc 2011; 45: 359-364.
  3. Dimitriou R, Jones E, McGonagle D, Giannoudis PV. Bone regeneration: Current concepts and future directions. BMC Medicine 2011; 9: 66. https://doi.org/10.1186/1741-7015-9-66
  4. Jackson LC, Pacchiana PD. Common complications of fracture repair. Clin Tech Small Anim Pract 2004; 19: 168-179. https://doi.org/10.1053/j.ctsap.2004.09.008
  5. Kim DJ. Autogenous bone graft and bone substitutes. J Korean Soc Spine Surg 2008; 15: 54-65. https://doi.org/10.4184/jkss.2008.15.1.54
  6. Kudo K, Shoji M, Yokota M, Fujiok Y. Evaluation of mandibular reconstruction technique following resection of malignant tumors in the oral cavity. J Oral Maxillofac Surg 2006; 50: 14-21.
  7. Lissenberg-Thunnissen SN, Gorter DJJD, Sier CFM, Schipper IB. Use and efficacy of bone morphogenetic proteins in fracture healing. Int Orthop 2011; 35: 1271-1280. https://doi.org/10.1007/s00264-011-1301-z
  8. Milovancev M, Muir P, Manley PA, Seeherman HJ, Schaefer S. Clinical application of recombinant human bone morphogenetic protein-2 in 4 Dogs. Vet Surg 2007; 36: 132-140. https://doi.org/10.1111/j.1532-950X.2007.00245.x
  9. Nandi SK, Roy S, Mukherjee P, Kundu B, De DK, Basu D. Orthopaedic applications of bone graft and graft substitutes: a review. Indian J Med Res 2010; 132: 15-30.
  10. Ogunlade SO, Arotiba JT, Fasola AO. Autogenous corticocancellous iliac bone graft in reconstruction of mandibular defect: point of technique. Afr J Biomed Res 2010; 13: 157-160.
  11. Piermattei DL, Flo GL, DeCamp CE, Brinker WO. Delayed union and nonunion. In: Brinker, piermattei, and flo's handbook of small animal orthopedics and fracture repair, 4th ed. St. Louis: Saunders Elsevier. 2006: 168-171.
  12. Pogrel MA, Podlesh S, Anthony J, Alexander J, A comparison of vascularized and non vascularized bone grafts for reconstruction of mandibular continuity defects. J Oral Maxillofac Surg 1997; 55: 1200-1205. https://doi.org/10.1016/S0278-2391(97)90165-8
  13. Tobias KM, Johnston SA. Delayed unions, nonunions, and malunions. In: Veterinary Surgery: Small Animal. 1st ed. St. Louis: Elsevier Saunders. 2012: 647-651.