Bone morphogenic protein and its application in trauma cases: A current concept update

Background: Bone morphogenic proteins (BMP) have shown tremendous potential in bone formation at fracture sites and at non-union sites. Animal studies and limited human studies have proven their efficacy as an alternative or enhancer of autologus bone graft in bone regeneration. The action of BMP is mediated through receptor kinases and transcription factors called Smads that regulate the expression of target genes. In preclinical studies, it was observed that BMP is relatively devoid of adverse effects and carcinogenicity but further studies are needed to clarify the issue of ectopic bone formation before its extensive use in humans. Materials and methods: This review article intends to give brief information on biology and basic science of BMP and provide an overview on the current research data on clinical application of BMP in the treatment of fractures and difficult non-unions. Results: Various studies have shown that BMP holds promise in the management of delayed unions and recalcitrant non-unions. It has also been observed to initiate faster heating resulting in less pain and infection at the fracture site in open fractures. However the role of BMP in fresh fractures is debatable. Conclusion: Judicious use of BMP in certain clinical scenarios may revolutionise management of non-unions and delayed unions. The major constraints for routine use of BMP are inadequate clinical trials in humans and the need to comprehensively assess the cost-effectiveness and budget impact of BMP, (c) 2007 Published by Elsevier Ltd.