Treatment of long bone non-union with demineralized bone matrix: a systematic review
Ryan N McIlwain, Elizabeth R Powell, Robin M Litten, Alexis N Alders, Joey P JohnsonAbstract
Background
Non-union is a challenging complication following long bone fractures. Demineralized bone matrix (DBM) has been increasingly utilized, however, its role in managing long bone non-union remains unclear. This systematic review evaluates the published research on the effectiveness of DBM in treating long bone non-union.
Sources of data
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, PubMed, Embase, and Scopus were searched from inception to March 2026 for studies assessing DBM use in adult long bone non-union.
Areas of agreement
Eight studies including 340 patients were included. DBM was used alone or combined with autologous bone marrow concentrate (BMC), platelet-rich fibrin (PRF), platelet-rich plasma (PRP), or cancellous allograft chips. Union rates were similar when comparing DBM and iliac crest bone grafting (ICBG). DBM-treated patients achieved 79%–100% union (mean time to union between 3.7 and 11.9 months) versus 80%–100% for ICBG. Complications were minimally reported with no DBM-specific adverse events.
Areas of controversy
Significant heterogeneity existed in DBM formulation, volume, and administration strategies. Studies utilized putty, strips, and injectable formulations, with volumes ranging 1–10 cc. DBM was also variably combined with PRP, BMC, or cancellous allograft chips. Outcome reporting was not standardized.
Growing points
DBM appears to be an effective grafting strategy across diverse clinical applications and may offer a viable alternative to autologous grafting.
Areas timely for developing research
Further high-quality randomized controlled trials with consistent outcome measures are needed to define optimal use of DBM in treating long bone non-union.