Treatment of long bone non-union with demineralized bone matrix: a systematic review

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.