We have presented a case of a prolonged tibial non-union, which was unsuccessfully treated with autograft but successfully treated with BMPs.
Many techniques have been developed to aid the healing of non-unions, including fixation techniques (internal and external), bone grafts and substitutes, and electromagnetic stimulation; however, the gold standard still remains autologous bone graft.5
The success of autologous bone graft lies in its osteoconductive and osteoinductive properties; however, there is an associated donor site morbidity with increased postoperative pain, increased intraoperative blood loss and extended operative time.6
BMPs have been used for a variety of purposes to improve bone healing ranging from acute closed and open fracture management,7
and fracture non-unions (tibial and scaphoid).10 11
In these cases, BMP has proved successful by not only initiating bone formation through the induction of cellular differentiation in mesenchymal cells but also providing a osteoconductive scaffold allowing ingrowth of bone into the defect. In a review of the literature, Garrison et al
demonstrated that there was no significant difference in the healing rates of tibial non-union between patients who received BMP versus autologous grafts; however, the autologous graft group did have the associated donor site morbidity.5
In the majority of these cases, the BMP is used in combination with surgical fixation either internal or external; however, in our case, the patient was only supported in an aircast boot postoperatively.
Our case demonstrates the use of BMPs in a complex tibial non-union, where other attempts to unite the fracture had failed, without additional surgical fixation.
- BMPs can be used to treat a non-union even when autograft has failed.
- The combination of BMPs and bone void filler can be used to fill a bone defect in a non-union.
- There is no need for any additional surgical fixation when BMPs and bone void fillers are used to treat tibial non-unions with bone defect.