Mussab RM, Khan S, Javed H, Arqam SM, Rimsha S, Javaid SA. Bone morphogenetic protein alone vs in combination with bone graft in management of non-union of tibia fractures. World J Clin Cases 2026; 14(17): 119557 [DOI: 10.12998/wjcc.v14.i17.119557]
Corresponding Author of This Article
Raja Muhammad Mussab, Orthopaedics and Trauma, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Sindh, Pakistan. mussabafaq@hotmail.com
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Orthopedics
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Mussab RM, Khan S, Javed H, Arqam SM, Rimsha S, Javaid SA. Bone morphogenetic protein alone vs in combination with bone graft in management of non-union of tibia fractures. World J Clin Cases 2026; 14(17): 119557 [DOI: 10.12998/wjcc.v14.i17.119557]
World J Clin Cases. Jun 16, 2026; 14(17): 119557 Published online Jun 16, 2026. doi: 10.12998/wjcc.v14.i17.119557
Bone morphogenetic protein alone vs in combination with bone graft in management of non-union of tibia fractures
Raja Muhammad Mussab, Sharjeel Khan, Hadia Javed, Shehanshah Muhammad Arqam, Shehzadi Rimsha, Safeer Ahmad Javaid
Raja Muhammad Mussab, Sharjeel Khan, Hadia Javed, Shehanshah Muhammad Arqam, Shehzadi Rimsha, Safeer Ahmad Javaid, Orthopaedics and Trauma, Jinnah Postgraduate Medical Centre, Karachi 75510, Sindh, Pakistan
Author contributions: Mussab RM, Khan S, Javed H, Arqam SM, Rimsha S and Javaid SA designed the research study; Mussab RM, Khan S, Javed H and Arqam SM performed the research; Mussab RM, Khan S, Rimsha S and Javaid SA contributed to data collection and data interpretation; Mussab RM, Khan S ,Rimsha S, Javaid SA and Javed H wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: Ethical approval was granted by the Institutional Review Board of Jinnah Postgraduate Medical Centre.
Informed consent statement: Signed informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Raja Muhammad Mussab, Orthopaedics and Trauma, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Sindh, Pakistan. mussabafaq@hotmail.com
Received: February 2, 2026 Revised: March 8, 2026 Accepted: April 9, 2026 Published online: June 16, 2026 Processing time: 124 Days and 7 Hours
Abstract
BACKGROUND
Both bone morphogenetic protein (BMP) and bone graft have been shown to promote healing in fracture non-unions.
AIM
To compare the effectiveness of BMP alone vs BMP combined with bone graft in achieving radiological union in tibial non-union fractures over 3 months after intervention.
METHODS
A retrospective cohort study was conducted, collecting data from January to July 2023. A total of 126 participants with tibial non-unions were categorized into either a BMP group (n = 63) or a BMP with bone graft group (n = 63). The radiological union was assessed at 3 months post-surgery. χ² tests were applied to compare union rates. Stratified analyses were conducted to examine union outcomes across subgroups based on age, gender, injury mechanism, fracture type, diabetes status, and non-union duration.
RESULTS
Radiological union was achieved in 61.9% of the BMP-alone group compared to 22.2% in the BMP with bone graft group (P < 0.001). Subgroup analyses showed that BMP alone had higher union rates in younger patients and female participants, patients with open fractures, those with diabetes, and cases with non-union duration over three months. BMP alone achieved an 81.4% union rate in diabetic participants vs 46.7% in the BMP with bone graft group. In patients with non-union duration exceeding three months, BMP alone had a union rate of 78.6% compared to 12.9% in the combined treatment group.
CONCLUSION
BMP alone demonstrated superior radiological union outcomes in tibial non-unions compared to BMP combined with bone graft, particularly in patients with specific characteristics such as diabetes, longer non-union duration, and open fractures.
Core Tip: Non-union of tibial fractures remains a significant challenge in orthopaedic trauma practice, often associated with prolonged morbidity and a substantial economic burden on healthcare systems. Bone morphogenetic proteins (BMPs) have emerged as a promising biological agent in fracture healing; however, their use in clinical practice, either alone or in combination with bone grafting techniques, remains variable and sometimes controversial due to cost-effectiveness and clinical outcomes. Our study directly compares the outcomes of BMP use alone vs in combination with autologous bone grafts in managing tibial non-unions. This manuscript contributes provides valuable insights that can aid clinical decision-making, particularly in resource-limited settings where the optimal use of biologics must be balanced against surgical and economic factors.
