In the past autogenous bone grafting has been the mainstay of treatment in patients with fracture non-unions. The harvesting of bone graft is, however associated with significant donor site morbidity. Recently there has been much interest in the use of synthetic osteo-inductive agents.

We performed a review series of thirteen patients with sixteen non-unions in whom op-1, a bone morphogenetic protein (available commercially as Osigraft) was used to promote union.

This was a retrospective chart review and union was judged on the basis of radiological union as reported by the radiology department and documented by the surgeon responsible and clinical union based on the ability to weight bear with minimal or no pain as documented in the patients’ records.

At nine months twelve of sixteen non-unions (75%) had achieved clinical and radiographic union. Three patients had repeat grafting, all of whom went on to union. Mean time to grafting after initial treatment for all patients was 8.9 +/−6.1 months. Mean time to union was 5.1 +/− 1.6 months.

We conclude that the use of osteo-inductive agents, in particular BMP-7 (op-1) results in good clinical and radiological outcomes. What remains unclear is whether they are superior to the traditional approach of autogenous grafting.