Comparative efficacy of 2 different demineralized bone matrix allografts in treating long-bone nonunions in heavy tobacco smokers.

Smoking impairs bone healing and increases the risk for complications associated with nonunions. The efficacies of 2 different allografts, Grafton (demineralized bone matrix [DBM] in a gel-like glycerol carrier) and Orthoblast (DBM with a reverse thermal poloxamer carrier) were examined with respect to nonunions in patients who reported heavy tobacco use. The Grafton allograft was used in 25 patients, and the Orthoblast allograft was used in 13 patients. All patients smoked more than half a pack of cigarettes a day and did not use electric stimulators. A successful graft was defined as healing on the first graft attempt without complications or later regraft. The Grafton and Orthoblast success rates were 52% and 85%, respectively (P = .077). The unique thermal properties of the Orthoblast reverse poloxamer, which may enhance DBM osteoinduction, may account for the difference in success rates. Although results failed to reach statistical significance, the large difference and high likelihood ratio (4.2) between the 2 groups suggest that perhaps not all commercially available allografts may necessarily perform with the same efficacy with respect to heavy smokers.