A Randomized Controlled Cost Study of Infuse BMP 2 vs Iliac Crest Autograft for Non Union of Long Bone Fractures

We propose a multi-centre Canadian randomized Study wherein 80 patients are randomized (put in groups by no standard pattern ie. flipping a coin) to receive both autograft (sample of your own bone: iliac crest) and allograft (bone chips from bone bank) or "infuse" (synthetic bone morphogenic protein) and allograft using locked plates. Locked plates are surgical plates placed on the fracture in which the screws lock into the plate when they have been completely screwed into the bone through holes on the plate. Our objective is to assess the total cost of the patients treated in both study group and the benefits of the Infuse by comparing the new bone formation in the fracture site.

We will monitor critical aspects of operative care and rehabilitation at regular intervals, up to 2 year after surgery. We will independently monitor revision surgery (surgeries to repair a previous surgery) rates. We will also assess patients for functional health and quality of life outcomes.

• Infuse Bone Morphogenic Protein (BMP) 2 (Device): "Infuse" is a synthetic bone morphogenic protein which means it has the ability to help your bone to form and heal if inserted in the fracture site. "Infuse" may be the first commercially available product approved by Health Canada to accelerate the healing of long bone non-unions requiring surgical intervention.
• iliac crest autograft (Procedure): A piece of the patients iliac crest bone is take and mixed with bone from a bone bank to supplement the bone loss in the fracture

Primary outcomes

• cost analysis based on length of hospital stay, allograft, blood products and costs associated with complications and/ or re-admission. [2 years]

Secondary outcomes

• Secondary efficacy end points will be the radiographic assessment of healing (RUST scale), the clinical assessment of weight-¬bearing status at 6 months post treatment, and the incidence of additional surgical/medical interventions to promote healing. [2 years]

Sex: All, ages: 18 Years to any

Inclusion Criteria:

Patients must meet all of the following criteria to be eligible for entry into the study:

a) Patients must require open surgical treatment of non-union of a diaphyseal fracture of the tibia, humerus, femur, radius or ulna sustained secondary to trauma.

c) Patients must be candidates for surgical treatment with an intramedullary nail or locked or unlocked plate.

d) Patients must have a fracture of the diaphysis as defined for that specific bone.

e) Patients must show radiographic evidence of skeletal maturity (closed epiphyseal plates).

Exclusion Criteria:

Patients with any of the following criteria, are not eligible for entry into the study:

1. Patients requiring mechanical fixation other than Intramedullary nailing or plating (i.e. no external fixation)
2. Patients with fractures that fall outside the diaphysis defined for the specific bone in question, i.e. no metaphyseal fractures.
3. Patients with segmental circumferential bone loss >4cm.
4. Patients whose fractures are the result of a tumour
5. Infection per se, does not result in exclusion but it must be treated and the soft tissue envelope closed prior to randomization
6. Patients with known metabolic bone disease (other than osteoporosis) which would negatively impact on the bone healing process.
7. Patients with known sensitivity to collagen.
8. Patients who are pregnant or breastfeeding at the time of study enrolment.
9. Patients currently being treated with radiation, chemotherapy, immunosuppression, or steroid therapy.
10. Patients receiving any other investigational drug or treatment.
11. Patients who have other injuries or conditions such as they are unable to communicate or consent

m)Patients with known breast or prostate cancer

f) Patients must be able and willing to provide informed consent, to complete study assessments, and to be followed for the period of the study.

• Ross K Leighton, MD, Principal investigator, CDHA