Skip to main content
Top
Published in: Journal of Orthopaedic Surgery and Research 1/2015

Open Access 01-12-2015 | Research article

Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures

Authors: Albert Christersson, Bengt Sandén, Sune Larsson

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2015

Login to get access

Abstract

Background

Recombinant human platelet-derived growth factor BB (rhPDGF-BB) combined with an osteoconductive scaffold (β-TCP) has been demonstrated to increase bone formation, but rhPDGF-BB has not been studied in human fractures. The purpose of this study was to evaluate the safety and potential use of locally administered rhPDGF-BB/β-TCP (Augment®) in acute wrist fractures.

Methods

Forty patients with unstable distal radial fracture were randomized to closed reduction and external fixation alone (n = 20) or combined with injection of rhPDGF-BB/β-TCP (Augment®) into the fracture (n = 20). All patients were followed for 24 weeks. Outcome was based on adverse events, fracture displacement on radiographs, fracture healing, range of motion, grip strength, pain, and the disability of the arm, shoulder and hand (DASH) score.

Results

There were no serious adverse events in the study, but the pin tract infection rate was significantly lower in the Augment® group. There was no difference between the groups in fracture healing time, based on number of healed cortices or fracture displacement. The Augment® group had an early temporary significant decrease in wrist flexion, but no difference in range of motion at 24 weeks. There were no differences between the two treatment groups for any other outcome variables.

Conclusion

rhPDGF-BB/β-TCP (Augment®) is safe and convenient for local administration into wrist fractures. In this pilot study, we could not detect any reduced healing time in the Augment® group although potential efficacy should be addressed in larger studies.

Clinical trial registration number

The clinical trial registration number for the study protocol is BMPI-2014-02-E.
Literature
1.
go back to reference Gruber R, Karreth F, Frommlet F, Fischer MB, Watzek G. Platelets are mitogenic for periosteum-derived cells. J Orthop Res Official Publ Orthop Res Soc. 2003;21(5):941–8.CrossRef Gruber R, Karreth F, Frommlet F, Fischer MB, Watzek G. Platelets are mitogenic for periosteum-derived cells. J Orthop Res Official Publ Orthop Res Soc. 2003;21(5):941–8.CrossRef
3.
go back to reference Heldin CH, Westermark B. Mechanism of action and in vivo role of platelet-derived growth factor. Physiol Rev. 1999;79(4):1283–316.PubMed Heldin CH, Westermark B. Mechanism of action and in vivo role of platelet-derived growth factor. Physiol Rev. 1999;79(4):1283–316.PubMed
4.
go back to reference Mitlak BH, Finkelman RD, Hill EL, Li J, Martin B, Smith T, et al. The effect of systemically administered PDGF-BB on the rodent skeleton. J Bone Miner Res Official J Am Soc Bone Miner Res. 1996;11(2):238–47.CrossRef Mitlak BH, Finkelman RD, Hill EL, Li J, Martin B, Smith T, et al. The effect of systemically administered PDGF-BB on the rodent skeleton. J Bone Miner Res Official J Am Soc Bone Miner Res. 1996;11(2):238–47.CrossRef
5.
go back to reference Pfeilschifter J, Oechsner M, Naumann A, Gronwald RG, Minne HW, Ziegler R. Stimulation of bone matrix apposition in vitro by local growth factors: a comparison between insulin-like growth factor I, platelet-derived growth factor, and transforming growth factor beta. Endocrinology. 1990;127(1):69–75.CrossRefPubMed Pfeilschifter J, Oechsner M, Naumann A, Gronwald RG, Minne HW, Ziegler R. Stimulation of bone matrix apposition in vitro by local growth factors: a comparison between insulin-like growth factor I, platelet-derived growth factor, and transforming growth factor beta. Endocrinology. 1990;127(1):69–75.CrossRefPubMed
6.
go back to reference Nash TJ, Howlett CR, Martin C, Steele J, Johnson KA, Hicklin DJ. Effect of platelet-derived growth factor on tibial osteotomies in rabbits. Bone. 1994;15(2):203–8.CrossRefPubMed Nash TJ, Howlett CR, Martin C, Steele J, Johnson KA, Hicklin DJ. Effect of platelet-derived growth factor on tibial osteotomies in rabbits. Bone. 1994;15(2):203–8.CrossRefPubMed
7.
go back to reference Al-Zube L, Breitbart EA, O’Connor JP, Parsons JR, Bradica G, Hart CE, et al. Recombinant human platelet-derived growth factor BB (rhPDGF-BB) and beta-tricalcium phosphate/collagen matrix enhance fracture healing in a diabetic rat model. J Orthop Res Official Publ Orthop Res Soc. 2009;27(8):1074–81.CrossRef Al-Zube L, Breitbart EA, O’Connor JP, Parsons JR, Bradica G, Hart CE, et al. Recombinant human platelet-derived growth factor BB (rhPDGF-BB) and beta-tricalcium phosphate/collagen matrix enhance fracture healing in a diabetic rat model. J Orthop Res Official Publ Orthop Res Soc. 2009;27(8):1074–81.CrossRef
8.
go back to reference Bordei P. Locally applied platelet-derived growth factor accelerates fracture healing. J Bone Joint Surg. 2011;93(12):1653–9.CrossRef Bordei P. Locally applied platelet-derived growth factor accelerates fracture healing. J Bone Joint Surg. 2011;93(12):1653–9.CrossRef
9.
go back to reference Hollinger JO, Onikepe AO, MacKrell J, Einhorn T, Bradica G, Lynch S, et al. Accelerated fracture healing in the geriatric, osteoporotic rat with recombinant human platelet-derived growth factor-BB and an injectable beta-tricalcium phosphate/collagen matrix. J Orthop Res Official Publ Orthop Res Soc. 2008;26(1):83–90.CrossRef Hollinger JO, Onikepe AO, MacKrell J, Einhorn T, Bradica G, Lynch S, et al. Accelerated fracture healing in the geriatric, osteoporotic rat with recombinant human platelet-derived growth factor-BB and an injectable beta-tricalcium phosphate/collagen matrix. J Orthop Res Official Publ Orthop Res Soc. 2008;26(1):83–90.CrossRef
10.
go back to reference Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, et al. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005;76(12):2205–15.CrossRefPubMed Nevins M, Giannobile WV, McGuire MK, Kao RT, Mellonig JT, Hinrichs JE, et al. Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial. J Periodontol. 2005;76(12):2205–15.CrossRefPubMed
11.
go back to reference Daniels T, DiGiovanni C, Lau JT, Wing K, Younger A. Prospective clinical pilot trial in a single cohort group of rhPDGF in foot arthrodeses. Foot Ankle Int. 2010;31(6):473–9.CrossRefPubMed Daniels T, DiGiovanni C, Lau JT, Wing K, Younger A. Prospective clinical pilot trial in a single cohort group of rhPDGF in foot arthrodeses. Foot Ankle Int. 2010;31(6):473–9.CrossRefPubMed
12.
go back to reference Digiovanni CW, Baumhauer J, Lin SS, Berberian WS, Flemister AS, Enna MJ, et al. Prospective, randomized, multi-center feasibility trial of rhPDGF-BB versus autologous bone graft in a foot and ankle fusion model. Foot Ankle Int. 2011;32(4):344–54.CrossRefPubMed Digiovanni CW, Baumhauer J, Lin SS, Berberian WS, Flemister AS, Enna MJ, et al. Prospective, randomized, multi-center feasibility trial of rhPDGF-BB versus autologous bone graft in a foot and ankle fusion model. Foot Ankle Int. 2011;32(4):344–54.CrossRefPubMed
13.
go back to reference DiGiovanni CW, Lin SS, Baumhauer JF, Daniels T, Younger A, Glazebrook M, et al. Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/beta-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am. 2013;95(13):1184–92.CrossRefPubMed DiGiovanni CW, Lin SS, Baumhauer JF, Daniels T, Younger A, Glazebrook M, et al. Recombinant human platelet-derived growth factor-BB and beta-tricalcium phosphate (rhPDGF-BB/beta-TCP): an alternative to autogenous bone graft. J Bone Joint Surg Am. 2013;95(13):1184–92.CrossRefPubMed
14.
go back to reference Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther Official Publ Am Occup Ther Assoc. 1989;43(7):444–7.CrossRef Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther Official Publ Am Occup Ther Assoc. 1989;43(7):444–7.CrossRef
15.
go back to reference Zachee B, Roosen P, Mc Aechern AG. The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients. Acta Orthop Belg. 1991;57(3):266–71.PubMed Zachee B, Roosen P, Mc Aechern AG. The dynamic axial fixator in fractures of the tibia and femur. A retrospective study in 98 patients. Acta Orthop Belg. 1991;57(3):266–71.PubMed
16.
go back to reference Lee KB, Taghavi CE, Murray SS, Song KJ, Keorochana G, Wang JC. BMP induced inflammation: a comparison of rhBMP-7 and rhBMP-2. J Orthop Res: Official Publ Orthop Res Soc. 2012;30(12):1985–94.CrossRef Lee KB, Taghavi CE, Murray SS, Song KJ, Keorochana G, Wang JC. BMP induced inflammation: a comparison of rhBMP-7 and rhBMP-2. J Orthop Res: Official Publ Orthop Res Soc. 2012;30(12):1985–94.CrossRef
17.
go back to reference Perri B, Cooper M, Lauryssen C, Anand N. Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study. Spine J Official J North Am Spine Soc. 2007;7(2):235–9.CrossRef Perri B, Cooper M, Lauryssen C, Anand N. Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion: a case study. Spine J Official J North Am Spine Soc. 2007;7(2):235–9.CrossRef
18.
go back to reference Benglis D, Wang MY, Levi AD. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery. 2008;62(5 Suppl 2):ONS423–31. discussion ONS431. Benglis D, Wang MY, Levi AD. A comprehensive review of the safety profile of bone morphogenetic protein in spine surgery. Neurosurgery. 2008;62(5 Suppl 2):ONS423–31. discussion ONS431.
19.
go back to reference Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A Phase III Randomized Placebo-Cont Double-Blind Study. Diabetes Care. 1998;21(5):822–7.CrossRefPubMed Wieman TJ, Smiell JM, Su Y. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (becaplermin) in patients with chronic neuropathic diabetic ulcers. A Phase III Randomized Placebo-Cont Double-Blind Study. Diabetes Care. 1998;21(5):822–7.CrossRefPubMed
Metadata
Title
Prospective randomized feasibility trial to assess the use of rhPDGF-BB in treatment of distal radius fractures
Authors
Albert Christersson
Bengt Sandén
Sune Larsson
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2015
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-015-0174-z

Other articles of this Issue 1/2015

Journal of Orthopaedic Surgery and Research 1/2015 Go to the issue