Systematic review and meta-analysis of bone morphogenetic protein for the treatment of acute tibial fracture

objective: Bone morphogenetic proteins have the function of inducing and promoting bone growth and formation. However, there is controversy between the research results of the treatment of acute tibial fracture with bone morphogenetic proteins, which makes the effect of bone morphogenetic proteins unclear. Meta-analysis was used to systematically evaluate the efficacy and safety of bone morphogenetic proteins for the treatment of acute tibial fracture. METHODS: PubMed, Elsevier, Web of Science, Cochrane Library, CNKI and Wanfang databases were searched to retrieve the clinical controlled trials of bone morphogenetic proteins for acute tibial fracture published before February 2020. Quality evaluation, bias risk assessment and data extraction of the included literatures were performed. Meta-analysis of outcome indicators was performed using RevMan 5.1 software provided by Cochrane system. RESULTS: (1) Seven articles were enrolled for meta-analysis, including six randomized controlled trials and one cohort study. A total of 1 256 cases of acute tibial fracture were included, with 793 cases in bone morphogenetic protein group and 463 cases in control group. (2) Meta-analysis results showed that bone morphogenetic proteins could not significantly improve the healing rate (P=0.07), but reduce the secondary intervention rate [RR=0.64, 95%CI(0.49, 0.84), P=0.001]. The application of bone morphogenetic proteins had no significant effect on postoperative pain, infection, hardware failure, edema and swelling (P > 0.05). Bone morphogenetic proteins significantly increased the incidence of heterotopic ossification and soft tissue calcification [RR=2.89, 95%CI(1.40, 5.95), P=0.004]. As for patients with open tibial fractures, bone morphogenetic proteins significantly improved the healing rate [RR=1.16, 95%CI(1.04, 1.30), P=0.009]. CONCLUSION: On the basis of conventional treatment, the application of bone morphogenetic proteins significantly reduces the secondary intervention rate and is more suitable for the auxiliary treatment of complex open tibial fracture. In addition, the higher rate of heterotopic ossification and soft tissue calcification is related to bone morphogenetic protein.