Clinical and Radiologic Outcomes of NOVOSIS (rhBMP-2 With Hydroxyapatite Carrier) Grafting for Scaphoid Waist Nonunion: A Preliminary Clinical Study.
Source: PubMed, NCBI / U.S. National Library of Medicine
Scaphoid nonunion remains a challenging problem due to limited vascularity and carpal malalignment. Although autologous bone grafting remains the standard of care, donor-site morbidity and technical demands can be substantial. NOVOSIS, a composite of recombinant human bone morphogenetic protein-2 (rhBMP-2) and a hydroxyapatite (HA) carrier, has shown osteoinductive and osteoconductive potential in other orthopedic applications, but its clinical efficacy in scaphoid nonunion has not been established. Seven consecutive patients with scaphoid waist nonunion underwent fixation using two 2.3-mm headless compression screws and NOVOSIS application between August 2023 and December 2024. All patients were followed for a minimum of 12 months (mean 12.4 months; range 12-14). Clinical outcomes were assessed using visual analogue scale (VAS), range of motion (ROM), and Mayo Wrist Score (MWS). Radiographic parameters included lateral intrascaphoid angle (LISA) and scapholunate angle (SLA). Paired t-tests compared pre- and postoperative values. All patients achieved radiographic union at final follow-up. VAS scores improved from 4.9 ± 1.2 to 0.4 ± 0.8 (p < 0.001), and MWS from 59.3 ± 7.3 to 94.3 ± 5.4 (p < 0.001). LISA improved from 51.7° ± 13.6° to 31.5° ± 5.1° (p = 0.007), and SLA from 65.7°Ȁ
Abstract
Scaphoid nonunion remains a challenging problem due to limited vascularity and carpal malalignment. Although autologous bone grafting remains the standard of care, donor-site morbidity and technical demands can be substantial. NOVOSIS, a composite of recombinant human bone morphogenetic protein-2 (rhBMP-2) and a hydroxyapatite (HA) carrier, has shown osteoinductive and osteoconductive potential in other orthopedic applications, but its clinical efficacy in scaphoid nonunion has not been established. Seven consecutive patients with scaphoid waist nonunion underwent fixation using two 2.3-mm headless compression screws and NOVOSIS application between August 2023 and December 2024. All patients were followed for a minimum of 12 months (mean 12.4 months; range 12-14). Clinical outcomes were assessed using visual analogue scale (VAS), range of motion (ROM), and Mayo Wrist Score (MWS). Radiographic parameters included lateral intrascaphoid angle (LISA) and scapholunate angle (SLA). Paired t-tests compared pre- and postoperative values. All patients achieved radiographic union at final follow-up. VAS scores improved from 4.9 ± 1.2 to 0.4 ± 0.8 (p < 0.001), and MWS from 59.3 ± 7.3 to 94.3 ± 5.4 (p < 0.001). LISA improved from 51.7° ± 13.6° to 31.5° ± 5.1° (p = 0.007), and SLA from 65.7° ± 6.8° to 52.2° ± 8.8° (p = 0.006). No procedure-related complications, such as infection, ectopic bone formation, or donor-site morbidity, were observed. This preliminary clinical series demonstrated that NOVOSIS provided reliable union, functional recovery, and radiographic correction in scaphoid nonunion without donor-site morbidity. It may serve as a feasible alternative to autologous bone grafting and warrants further validation in larger studies.