Skip to main content

Long bone nonunions treated with autologous concentrated bone marrow-derived cells combined with dried bone allograft



Nowadays the treatment of long bone nonunion continues to be one of the most complex and debated topics due to the large number of failures. For several years, in the relevant literature three factors have been considered essential in the healing process: growth factors and hormones, osteoprogenitor cells (mesenchymal stem cells), and extracellular matrix. The mechanical stability of the fracture site is considered the fourth element of the “Diamond concept theory.” The aim of our study was to evaluate the validity of biological adjuvants of mechanical synthesis allowing a faster healing process of nonunions.

Materials and Methods

We dealt with 19 patients with long bone nonunion. All patients have been treated with concentrated mesenchymal stem cells without bone autologous transplant. We used the Extracell BMC-marrow aspirate protocol of Regen Lab. The radiographic parameters taken into account for the diagnosis of successful healing were the presence of a bridge callus, obliteration of the fracture line and bone cortical continuity. Clinically, the pain was investigated with VAS score (visual analogue scale), where zero means no pain and 10 the worst possible pain.


Radiographic investigation shows complete healing in 78.9 % (15 cases) with an average time to healing of 6.5 months (minimum healing time 80 days) corresponding also in complete remission of clinical symptoms.


The use of growth factors and autologous mesenchymal stem cells through the enforcement of system for tissue regeneration is a valid and innovative biotechnology technique for the treatment long bone nonunions.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Jain AK, Sinha S (2005) Feb infected nonunion of the long bones. Clin Orthop Relat Res 431:57–65

    PubMed  Article  Google Scholar 

  2. Calori GM, Tagliabue L, Colombo M, Mazza E, Albisetti W (2010) Long bone nonunions and bone defects GIOT vol l5–10

  3. Perren SM, Claes L. (2002) Biology and biomechanics in fracture management AO Principles of Fracture Management. Ruedi TP, Murphy WM /Edi/CIC 1.2:7–29

  4. Sarmiento A, Zagorsky JB, Zych GA, Latta LL, Capps CA (2000) Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am 82(4):478

    CAS  PubMed  Google Scholar 

  5. Lieberman JR, Daluiski A, Einhorn TA (2002) The role of growth factors in the repair of bone. Biology and clinical applications. Department of Orthopaedic Surgery, University of California at Los Angeles Medical Center, USA, p 90077

    Google Scholar 

  6. Drossea I, Volkmera E, Capanna R, De Biase P, Mutschlera W, Schiekera M (2008) Tissue engineering for bone defect healing: an update on a multi-component approach. Injury 39(Suppl 2):S9–S20

    Article  Google Scholar 

  7. Calori GM, Giannoudis V (2011) Enhancement of fracture healing with the diamond concept: the role of the biological chamber. Injury Int J Care Injured 42–2011:1191–1193

    Article  Google Scholar 

  8. Calori GM et al. (2010) Long bone nonunions and bone defects. GioT. 36:183–189

    Google Scholar 

  9. Wolff J (1986) Das Gesetz der Transformation der Knochen. Berlin: A. Hirschwald 1982. Transl. The law of bone remodelling. Springer, Berlin

  10. Weber BG, Cech O (1976) Pseudarthrosis. Grune and Stratton, New York

    Google Scholar 

  11. Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R (2011) Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury 42(6):591–8. (Epub 2011 May 4)

    Google Scholar 

  12. Judet T, Richard L, de Thomasson E, Arnault O (1990) Current role of decortication in problems of bone healing. Chirurgie 116(4–5):442–447

    CAS  PubMed  Google Scholar 

  13. Fayaz HC, Giannoudis PV, Vrahas MS, Smith RM, Moran C, Pape HC, Krettek C, Jupiter JB (2011) The role of stem cells in fracture healing and nonunion. Int Orthop 35(11):1587–1597. doi:10.1007/s00264-011-1338-z

    PubMed Central  PubMed  Article  Google Scholar 

  14. Capanna R, De Biase P, Saccardi R, Lombardini, Graziani, Mancini I (2006) Scaffold, stem cells and growth factors combination for tissue engineering: from laboratory to clinic. G.I.O.T. 32(suppl 1):S22–S27

  15. Dallari D, Fini M, Stagni C, Torricelli P, Nicoli Aldini N, Giavaresi G, Cenni E, Baldini N, Cenacchi A, Bassi A, Giardino R, Fornasari PM, Giunti A (2006) In vivo study on the healing of bone defects treated with bone marrow stromal cells, platelet-rich plasma, and freeze-dried bone allografts, alone and in combination., Published online 11 April 2006 in Wiley Inter Science ( doi:10.1002/jor.20112

  16. Cigni S, Scarabelli D, Strani M, Rovati D, Tarenzi A (2006) Demineralized bone matrix in orthopedic surgery G.I.O.T. 32:54–61

    Google Scholar 

  17. Faldini C, Miscione MT, D’Amato M, Fabbri D, Provenzale C, Calamelli C, Mazzotti A, Giannini Agosto S (2012) Il trattamento delle pseudoartrosi di avambraccio mediante placca e innesto omologo contrapposto. Giot 38:138–142

    Google Scholar 

  18. Faldini C, Miscione MT, Acri F, Chehrassan M, Bonomo M, Giannini S (2011) Use of homologous bone graft in the treatment of aseptic forearm nonunion. Musculoskelet Surg 95(1):31–35

    Google Scholar 

  19. Garg B, Goyal T, Kotwal PP, Sankineani SR, Tripathy SK (2012) Local distal radius bone graft versus iliac crest bone graft for scaphoid nonunion: a comparative study. Musculoskelet Surg (Epub ahead of print)

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations


Corresponding author

Correspondence to M. Scaglione.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Scaglione, M., Fabbri, L., Dell’Omo, D. et al. Long bone nonunions treated with autologous concentrated bone marrow-derived cells combined with dried bone allograft. Musculoskelet Surg 98, 101–106 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Long bone nonunions
  • Mesenchymal stem cells
  • Dried bone allograft
  • Pseudoarthrosis