Use of demineralized bone matrix in ankle/hindfoot fusion

Sixty-three patients who underwent complex ankle or hindfoot fusion had demineralized bone matrix placed in their fusion site to stimulate fusion. Thirty-seven patients had Grafton putty, a demineralized bone matrix product, and 26 patients had Orthoblast, a demineralized bone matrix mixed with crushed cancellous allograft bone placed to stimulate their fusion site. All patients were followed clinically and radiographically to fusion or nonunion. Of the 37 patients who had Grafton putty placed to stimulate ankle or hindfoot fusion, five (14%) developed a nonunion. Of the 26 patients who had Orthoblast placed to stimulate fusion, two (8%) developed a nonunion. These differences were not statistically significant. Nonunion rates of approximately 10% continue to be reported for ankle and hindfoot fusion procedures. In an attempt to minimize this complication, various bone graft substitutes have been used. We found no difference in efficacy of the two demineralized bone matrix compounds, and were not able to demonstrate a superior union rate compared to historical controls.