Heterotopic Ossification around the Knee after Internal Fixation of a Complex Tibial Plateau Fracture Combined with the Use of Demineralized Bone Matrix (DBM): A Case Report

Document Type : CASE REPORT

Authors

1 Department of Orthopaedic Surgery, Academic Medical Centre Amsterdam, the Netherlands.

2 Department of Orthopaedic Surgery, Academic Medical Centre, Meibergdreef 9, 1100 DD, Amsterdam, the Netherlands.

Abstract

Demineralized bone matrix has been successfully commercialized as an alternative bone graft material that not only can function as filler but also as an osteoinductive graft. Numerous studies have confirmed its beneficial use in clinical practice. Heterotopic ossification after internal fixation combined with the use of demineralized bone matrix has not been widely reported.
In this paper we describe a 39 year old male who sustained a complex articular fracture that developed clinically significant heterotopic ossification after internal fixation with added demineralized bone matrix. Although we cannot be sure that there is a cause-and-effect relation between demineralized bone matrix and the excessive heterotopic ossification seen in our patient, it seems that some caution in using demineralised bone matrix in similar cases is warranted. Also, given the known inter- and intraproduct variability, the risks and benefits of these products should be carefully weighed.

Keywords

References

  1. Urist MR. Bone: Formation by autoinduction. Science. 1965;150: 893-9.
  2. Kinney RC, Ziran BH, Hirshorn K, Schlatterer D, Ganey T. Demineralized bone   matrix for fracture healing: fact or fiction?. J Orthop Trauma. 2010;24:52-5.
  3. Bae HW, Zhao L, Kanim LE, Wong P, Delamarter RB, Dawson EG. Intervariability             and intravariability of bone morphogenetic proteins in commercially available demineralized bone matrix products. Spine (Phila Pa 1976). 2006; 31:1299-306.
  4. Dinopoulos HT, Giannoudis PV. Safety and efficacy of use of demineralised bone             matrix in orthopaedic and trauma surgery. Expert Opin Drug Saf. 2006;5: 847-66.
  5. Wildemann B, Kadow-Romacker A, Haas NP, Schmidmaier G. Quantification of various growth factors in different demineralized bone matrix preparations.J Biomed Mater Res A. 2007; 81(2):437-42.
  6. Bae H, Zhao L, Zhu D, Kanim LE, Wang JC, Delamarter RB. Variability across ten production lots of a single demineralized bone matrix product. J Bone Joint Surg Am. 2010;92(2):427-35.
  7. Hierholzer C, Sama D, Toro JB, Peterson M, Helfet DL. Plate fixation of ununited humeral shaft fractures: effect of type of bone graft on healing. J Bone Joint Surg Am. 2006;88: 1442-7.
  8. Zimmermann G, Moghaddam A. Allograft bone matrix versus synthetic bone graft substitutes.Injury. 2011; 42 :16-21.
  9. Heyd R, Strassmann G, Schopohl B, Zamboglou N. Radiation therapy for the prevention of heterotopic ossification at the elbow. J Bone Joint Surg Br. 2001;83:332-4.              
  10. Hamid N, Ashraf N, Bosse MJ, Connor PM, Kellam JF, Sims SH, et al. Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study. J Bone Joint Surg Am. 2010;92: 2032-8.
  11. Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: five- to 27-year follow-up results. J Orthop Trauma. 2007;21(1):5-10.
  12. Boraiah S, Paul O, Hawkes D, Wickham M, Lorich DG. Complications of recombinant human BMP-2 for treating complex tibial plateau fractures: a preliminary report. Clin Orthop Relat Res. 2009; 467: 3257-62.
  13. Axelrad TW, Steen B, Lowenberg DW,Creevy WR, Einhorn TA. Heterotopic ossification after the use of commercially available recombinant human bone morphogenetic proteins in four patients. J Bone Joint Surg Br. 2008;90: 1617-22.
  14. Wysocki RW, Cohen MS. Ectopic ossification of the triceps muscle after application of bone morphogenetic protein-7 to the distal humerus for recalcitrant nonunion: a case report. J Hand Surg Am. 2007;32: 647-50.
  15. Delimar D, Smoljanovic T, Bojanic I. Could the use of bone morphogenetic proteins in fracture healing do more harm than good to our patients?. Int Orthop. 2012;36: 683.
  16. Ritting AW, Weber EW, Lee MC. Exaggerated inflammatory response and bony resorption from BMP-2 use in a pediatric forearm nonunion. J Hand Surg Am. 2012; 37(2):316-21.
  17. Julka A, Shah AS, Miller BS. Inflammatory response to recombinant human bone morphogenetic protein-2 use in the treatment of a proximal humeral fracture: a case report. J Shoulder Elbow Surg. 2012; 21(1):12-6.
The Archives of Bone and Joint Surgery
Volume 2, Issue 4 - Serial Number 4
October 2014
Pages 250-254

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History

  • Receive Date: 30 June 2014
  • Revise Date: 10 December 2014
  • Accept Date: 02 September 2014

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