116 THE JOURNAL OF BONE AND JOINT SURGERY  CASE REPORT Bone morphogenetic protein 7 in the treatment of congenital pseudarthrosis of the tibia L. Fabeck, D. Ghafil, M. Gerroudj, R. Baillon, Ph. Delincé From CHU Saint Pierre, Brussels, Belgium  L. Fabeck, MD, PhD, Orthopaedic Surgeon, Professor  D. Ghafil, MD, Orthopaedic Surgeon  M. Gerroudj, MD, General Practitioner  R. Baillon, MD, Orthopaedic Surgeon  Ph. Delincé, MD, Orthopaedic Surgeon, Professor Department of Orthopaedic Surgery CHU Saint Pierre, 322 rue Haute, 1000 Brussels, Belgium. Correspondence should be sent to Dr L. Fabeck; e-mail: laurent_fabeck@ stpierre-bru.be ©2006 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.88B1. 16619 $2.00 J Bone Joint Surg [Br] 2006;88-B:116-18. Received 15 April 2005; Accepted after revision 6 September 2005 We describe a 13-year-old boy with atrophic tibial pseudarthrosis associated with neurofibromatosis who had undergone nine unsuccessful operations. Eventually, union was obtained by the use of bone morphogenetic protein 7 in conjunction with intramedullary stabilisation and autologous bone graft. Congenital pseudarthrosis of the tibia is a rare disorder, usually appearing during the first two years of life. Neurofibromatosis is present in approximately 40% to 50% of patients with pseudarthrosis and approximately 10% of patients with neurofibromatosis develop pseud- arthrosis of the tibia. Treatment is challenging and often disappointing and unsatisfactory out- comes may lead to amputation. 1 Operative treatment includes intramedul- lary rodding and grafting, limb lengthening, vascularised fibular transfer and the Ilizarov techniques. 2-5 However, even after multiple attempts to achieve bony union, 2-4 amputation may be needed. The osteogenic proteins are a class of natural growth factors of the bone morphogenetic pro- tein family (BMP) which stimulate bone regener- ation. 6 A specific member of this family is BMP- 7, known as human recombinant osteogenic protein number 1 (rh OP-1), which accelerates bone repair compared with a control fracture when injected into a fresh fracture model. 7 Case report The patient was born by normal delivery after an uneventful pregnancy. There was no family his- tory of congenital problems. At the age of nine months, ‘café-au-lait spots’ appeared on his back and abdomen. At 14 months, there was anterior bowing of the right leg and neurofibromatosis was diagnosed. When he had reached 20 months and began to walk, the leg was protected by an ankle-foot orthosis with an anterior shell. Fig. 1a Radiographs showing the tibia pre-operatively a) lateral and b) anteroposterior views. The boy had undergone nine unsuccessful surgical treatments. Fig. 1b