The use of bone morphogenetic proteins (BMPs) in treating the clinical challenge posed by fracture delayed and non-union is still under investigation. When used to supplement basic surgical management clinical trials white few in number have demonstrated that BMPs are effective and safe for human application and have an efficacy comparable with that of autologous bone-grafting and eliminate donor site morbidity and reduces the risk of infection at the recipient site. Level one evidence has shown that recombinant human bone morphogenetic protein-7 (rh-BMP-7 or OP-1) is a reasonable alternative to autologous bone grafting in the treatment of long bone non-unions. (C) 2007 Elsevier Ltd. All rights reserved.