Aims: The treatment of long bone non-union now days finds its gold standard in autologous bone grafting. Since this technique is affected by a high morbidity rate of the donor site, many studies tried to find valid alternatives to this procedure, but during the last few years the advances made in tissue engineering techniques opened new frontiers.

In this study BMPs/AGFs were used in posttraumatic long bone non-union and osseous defects to test their clinical and radiological effectiveness in order to find a valid alternative to autologous bone grafting.

Methods: The cases selected can be divided in two groups. Group A: Patients affected by long bones Non Union, 9 months minimum duration, who are judged not to heal by simply changing the osteosynthesis device. Group B: Patients with non neoplastic, posttrauma or post-resection osseous defects of a critical size that will probably not heal using traditional surgical techniques or for which such techniques are considered to be unsuitable.

Moreover, the overall recruitment period is 3 years during which 40 patients/year will be enrolled up to a total of 120 cases; half of these will be treated with rhBMP-7 and the other half with PRP.

Results: Only 66 patients can be evaluated as they have completed the minimum follow-up period of 9 months, 35 of whom have been treated with rhBMP-7 and 31 treated with PRP. Advanced results indicate the RX Healing rate was 85% for BMP-7 and 68% for PRP with a Clinical Healing rate of 88.5% and 68%; therefore a higher efficiency of BMP-7 over PRP was found, confirmed by a significant failure rate of 15% versus 32,3% between BMP-7 and PRP, respectively.

Conclusions: According to our results, the use of growth factors showed a similar effectiveness to autologous bone grafting with better tolerability, moreover, a relevant difference in healing/failure rate between rhBMP-7 and PRP is observed.

Thanks to recombinant DNA technique it is now possible to synthesise recombinant human osteogenic protein 1 (rh OP1), one of the best documented osteogenic proteins. This protein, linked to type 1 collagen as carrier, is the first drug with proven osteoinductive and osteoconductive properties approved for clinical use.

Osigraft (the commercial name of OP-1 and collagen) is also biocompatible, bioresorbable and lacks the risk of disease transmission. In the most challenging non-union, tibial non-union, the drug showed 80% efficacy as autograft with a better tolerability (i.e. lack of donor site complications) also in patients with previously failed autograft. Higher rates of success were also reported in recalcitrant long bone non-unions, i.e. a mean of 5 years of length of disease, incresaed number of previous surgeries.

Osigraft, also considering its physical characteristics, has to be implanted during the surgical procedure, with direct positioning at the non-union site; furthermore, its use is contraindicated in cases of infection of bone and infection/poor condition of surrounding soft tissues.

In our department we have treated up to now five patients with complex non-union of femoral neck and tibia; in three cases serious soft tissue conditions were present (crushing, infected necrosis) and one patient required plastic surgery. In all case we registered complete clinical and radiological healing after 3.5–7 months.

We also describe two cases of closed application of Osigraft, pushing the drug into the non-union site via a holed cannulated nail with the help of a probe under radioscopic control.