Vet Comp Orthop Traumatol 2011; 24(04): 289-293
DOI: 10.3415/VCOT-10-11-0155
Case Report
Schattauer GmbH

Treatment of a nonunion, secondary to gunshot fracture, of the distal radius with circular external fixation and rhBMP-2 in a cat

F. Arnault
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
,
P. Maitre
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
,
T. Cachon
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
,
C. Carozzo
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
2   RTi2B, Campus Veterinaire de Lyon, Marcy L’Etoile, France
,
D. Fau
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
2   RTi2B, Campus Veterinaire de Lyon, Marcy L’Etoile, France
,
J-. P. Genevois
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
,
E. Viguier
1   CHEVAC, VetAgro Sup, Campus Vétérinaire De Lyon Marcy L’Etoile, France
2   RTi2B, Campus Veterinaire de Lyon, Marcy L’Etoile, France
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Received:19. November 2010

Accepted:05. Mai 2011

Publikationsdatum:
21. Dezember 2017 (online)

Summary

Objective: To report the successful use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in the treatment of an ante-brachial non-union, secondary to gunshot fracture, stabilized with circular external fixation in a cat.

Procedure: Following a diagnosis of a highly comminuted gunshot fracture of the distal right radius and ulna, the fracture was stabilized with a circular external fixation. A two-ring frame was placed in closed fashion.

Results: The skin wound healed uneventfully by second intention in 21 days. Twenty-eight weeks after external fixation, bone healing was absent. 0.8mL of 0.2mg/mL of rhBMP-2 in two collagen sponges was placed in the bone defect. Eight weeks after rhBMP-2 implantation, an early bone healing response was noted on radiographic evaluation. Sixteen weeks after rhBMP-2 implantation, fracture union was achieved.

Discussion: To the authors’ knowledge, 160 ±g is the lowest reported dose of rhBMP-2 that leads to bony union in a cat. However as an individual case study, this report can not be used as evidence that rhBMP-2 at this lower dose is appropriate for use in all cats. Further studies are needed to establish the minimum efficient dose of rhBMP-2 in cats.

 
  • References

  • 1 Pavletic MM, Trout NJ.. Bullet, Bite, and burn wounds in dogs and cats. Vet Clin Small Anim 2006; 36: 873-893.
  • 2 Nolte DM, Fusco VF, Peterson ME.. Incidence of and predisposing factors for non union of fractures involving the appendicular skeleton in cats: 18 cases (1998–2002). J Am Vet Med Assoc 2005; 226: 77-82.
  • 3 Wallace AM, De la Puerta B, Trayhorn D. et al. Feline combined diaphyseal radial and ulnar fractures: a retrospective study of 28 cases. Vet Comp Orthop Traumatol 2009; 22: 38-46.
  • 4 Marcellin-Little DJ.. Fracture treatment with circular external fixation. Vet Clin Small Anim 1999; 29: 1153-1170.
  • 5 Mont MA, Ragland PS, Biggins B. et al. Use of bone morphogenetic proteins for musculoskeletal applications. An overview. J Bone Jt [Am] 2004; 86 (Suppl. 02) Suppl 41-55.
  • 6 Govender S, Csimma C, Genant HK. et al. Recombinant human bone morphogenetic protein 2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Jt Surg [Am] 2002; 84: 2123-2134.
  • 7 De Biase P, Capanna R.. Clinical applications of BMPs. Injury 2005; 36S: S43-S46.
  • 8 Spector DI, Keating JH, Boudrieau RJ.. Immediate mandibular reconstruction of a 5cm defect using rhBMP-2 after partial mandibulectomy in a dog. Vet Surg 2007; 37: 741-748.
  • 9 Lewis JR, Boudrieau RJ, Reiter AM. et al. Mandibular reconstruction after gunshot trauma in a dog by use of recombinant human bone morphogenetic protein 2. J Am Vet Med Assoc 2008; 233: 1598-1604.
  • 10 Boudrieau RJ, Mitchell SL, Seehermann H.. Mandibular reconstruction of a partial hemimandibulectomy in a dog with severe malocclusion. Vet Surg 2004; 33: 119-130.
  • 11 Itoh T, Mochizuki M, Fuda K. et al. Femoral non union fracture treated with recombinent human bone morphogenetic protein 2 in a dog. J Vet Med Sci 1998; 24: 164-168.
  • 12 Schmoekel HG, Webert FE, Hurter K. et al. Enhancement of bone healing using non glyosylated rhBMP2 released from a fibrin matrix in dogs and cats. J Small Anim Pract 2005; 46: 17-21.
  • 13 Bernard F, Furneaux R, Da Silva CA. et al. Treatment with rhBMP2 of extreme radial bone atrophy secondary to fracture management in an italian Greyhound. Vet Comp Orthop Traumatol 2008; 1: 64-68
  • 14 Milovancev M, Muir P, Manley PA. et al. Application of recombinant human bone morphogenetic protein 2 in 4 dogs. Vet Surg 2007; 36: 132-140.
  • 15 Fullington RJ, Otto CM.. Characterisics and management of gunshot wounds in dogs and cats: 84 cases (1986–1995). J Am Vet Med Assoc 1997; 210: 658-662.
  • 16 Bonath KH, Vannini R, Koch H. et al. Gunshots wounds: ballistics, physiopathology, surgical treatment. Tierartztl Prax. 1996; 24: 304-315.
  • 17 Gerhardsson L, Dahlin L, Knebel R. et al. Blood lead concentration after a shotgun accident. Environ Health Perspect 2002; 110: 115-117.
  • 18 Roux P, Pocock F.. Blood lead concentration in children after gunshot injuries. S Afr Med J 1988; 73: 580-582.
  • 19 Latte Y.. Bilan de 75 applications de la méthode d’Ilizarov:deuxième partie. [Ilizarov method outcome in 75 cats: Part 2]. Prat Med Chir Anim Comp 1995; 30: 141-160.
  • 20 Bilgili H, Dioszegi Z, Csebi P.. Detailed preoperative planning for fracture treatment with Ilizarov method in three dogs. Vet Comp Orthop Traumatol 2006; 3: 162-171.
  • 21 Rahal SC, Volpi RS, Vulcano LC. et al. Acute shortening and subsequent lengthening of the radius and the ulna for the treatment of an infected non union in a dog. Can Vet J 2001; 42: 724-726.
  • 22 Owen MA.. Use of the ilizarov method to manage a septic tibial fracture non union with a large cortical defect. J Small Anim Pract 2000; 41: 124-127.
  • 23 Lewis DD, Radasch RM, Beale BS. et al. Initial clinical experience with IMEX circular external skeletal fixation system. Part 2. Use in bone lengthening and correction of angular and rotational deformities. Vet Comp Orthop Traumatol 1999; 12: 118-127.
  • 24 Stallings JT, Lewis DD, Welch RD. et al. An introduction to distraction osteogenesis and the principles of the Ilizarov method. Vet Comp Orthop Traumatol 1998; 11: 59-67.
  • 25 Thomasini MD, Betts CW.. Use of the Ilizarov externl fixator in a dog. Vet Comp Orthop Traumatol 1991; 4: 70-76.
  • 26 Akeson WH Amiel D, Adel MF. et al. Effects of immobilization on joints. Clin Orthop Relat Res 1987; 219: 28-37.
  • 27 Behrens F, Kraft EL, Oegema TR.. Biomechnical changes in articular cartilage after joint immobilization by casting or external fixation. J Orthop Res 1989; 7: 335-343.
  • 28 Haapala J, Arokoski J, Pirttimaki J. et al. Incomplete restoration of immobilization induced softening of young beagle knee articular cartilage after 50 week remobilization. Int J Sports Med 2000; 21: 76-81.
  • 29 Lewis DD, Bronson DG, Samchukov ML. et al. Bio-mechanics of circular external skeletal fixation. Vet Surg 1998; 27: 454-464.
  • 30 Burny F.. La fixation externe elastique. [Elastic external fixation]. Rev Chir Orthop 1983; 69: 376-377.
  • 31 Fleming B, Paley D, Kristiansen T. et al. A biomechanical analysis of the Ilizarov external fixator. Clin Orthop 1989; 241: 95-105.
  • 32 Kenwright J, Richardson JB, Cunningham JL. et al. Axial movement and tibial fractures. A controlled randomized trial of treatment. J Bone Joint Surg Br 1991; 73: 654-659.
  • 33 Aronson J.. Temporal and spatial increases in blood flow during distraction osteogenesis. Clin Orthop 1994; 301: 124-131.
  • 34 Kirker Head CA.. Recombinant bone morphogenetic proteins: novel substances for enhancing bone healing. Vet Surg 1995; 245: 408-419.
  • 35 Volk SW, Diefenderfer DL, Chrsitopher SA. et al. Effects of osteogenic inducers on cultures of canine mesenchymal stem cells. Am J Vet Res 2005; 66: 1729-1737.
  • 36 Pluhar GE, Manley PA, Heiner JP. et al. The effect of recombinant human bone morphogenetic protein 2 on femoral reconstruction with an intercalary allograft in a dog model. J Orthop Res 2001; 19: 308-317.
  • 37 Sandhu HS, Kamin LE, Toth JM. et al. Experimental spinal fusion with recombinant human bone morphogenetic protein 2 without decortication of osseous elements. Spine 1997; 22: 1171-1180.
  • 38 Muschler GF, Hyodo A, Manning T. et al. Evaluation of human bone morphogenetic protein 2 in a canine spinal fusion model. Clin Orthop Relat Res 1994; 308: 229-240.
  • 39 Sumner DR, Turner TM, Urban T. et al. Locally delivered rhBMP2 enhances bone ingrowth and gap healing in a canine model. J Orthop Res 2004; 22: 58-65.
  • 40 Faria MLE, Lu Y, Heaney K. et al. Recombinant human bone morphogenetic protein 2 in absorbable collagen sponge enhances bone healing of tibial osteotomies in dogs. Vet surg 2007; 36: 122-131.
  • 41 Sciadini MF, Jonhson KD.. Evaluation of recombinant human bone morphogenetic protein 2 as a bone substitute in a canine segmental defect model. J Orthop Res 2000; 18: 289-302.
  • 42 Schmiedt CW, Lu Y, Heaney K. et al. Comparison of two doses of recombinant human bone morpho-genetic protein in absorbable collagen sponges for bone healing in dogs. Am J Vet Res 2007; 68: 834-840.
  • 43 Drespe IH, Polzhofer GK, Turner AS. et al. Animal models for spinal fusion. Spine 2005; 5: 209S-216S.
  • 44 David SM, Gruber HE, Meyer RA. et al. Lumbar spinal fusion using recombinant human bone morphogenetic protein in the canine. A comparison of three dosages and two carriers. Spine 1999; 24: 1973-1979.
  • 45 Riedel GE, Valentin Opran A.. Clinical evaluation of rhBMP2/ACS in orthopaedic trauma: a progress report. Orthopaedics 1999; 22: 663-665.
  • 46 Finkemeier CG.. Bone graft and bone graft substitutes. J Bone Jt Surg 2002; 84 A 454-464.
  • 47 Seeherman H.. The influence of delivery vehicles and their properties on the repair of segmental defects and fractures with osteogenic factors. J Bone Jt Surg 2001; 83 A S79-S81.
  • 48 Uludag H, Gao T, Porter TJ. et al. Delivery systems for BMPs: factors contributing to protein retention at an application site. J Bone Jt Surg 2001; 83 A S128-S135.
  • 49 Schmokel HG, Weber FE, Seiler G. et al. Treatment of nonunions with nonglycosylated recombinant human bone morphogenetic protein 2 delivered from a fibrin matrix. Vet Surg 2004; 33: 112-118.
  • 50 Cook SD, Baffes GC, Wolfe MW. et al. Recombinant human bone morphogenetic protein 7induces healing in a canine long bone segmental defect model. Clin Orthop Related Res 1994; 301: 302-312.
  • 51 Itoh T, Mochizuki M, Nishimura R. et al. Repair of ulnar segmental defect by recombinant human bone morphogenetic protein 2 in dogs. J Vet Med Sci 1998; 60: 451-458.