rhBMP-2 and Demineralized Bone Matrix Result in Similar Fracture Healing in Delayed- and Nonunion Treated with a Modified HernigouTMs Technique

INTRODUCTION Delayedand nonunion are common complications that occur after 510% of fractures. Iliac crest bone grafting, the current gold standard of treatment for nonunion, provides a limited source of grafting material and is associated with persistent donor site pain. Hernigou et al. reported the use of percutaneous injection of concentrated autologous bone marrow to treat nonunions with fracture gaps <5mm. Their series showed a healing rate of 88% at an average of 12 weeks. Our group has modified Hernigou’s technique by adding osteoinductive materials such as demineralized bone matrix (DBM) and recombinant human bone morphogenic protein-2 (rhBMP-2). We have also expanded the application of our technique to include patients with fracture gaps ≥5 mm and patients diagnosed with atypical bisphosphonate fractures. The purpose of our study is to compare the rate and duration of fracture healing between patients who received rhBMP-2 and those who received DBM. We also aim to compare the rate and duration of fracture healing between patients with and without atypical bisphosphonate fractures. Furthermore, we aim to evaluate the overall rate and duration of fracture healing in our case series to demonstrate the efficacy of our novel treatment strategy.