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Studies of isolated bone marrow-mesenchymal stem cells (BM-MSCs) and use in non-long-bone fractures were excluded. Statistical analysis was confounded by heterogeneous fracture fixation methods, treatment history, and scaffold use.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Our initial search yielded 430\u00a0publications, which was screened down to 25\u00a0studies. Successful treatment in aseptic nonunion was reported at 79\u2013100% (BM) and 50\u2013100% (BMAC). Septic nonunion rates were slightly better at 73\u2013100% (BM) and 83.3\u2013100% (BMAC). 18\/24 studies report union rates\u2009&gt;\u200980%. One study reports successful treatment of septic nonunion with BMAC and no antibiotics. A separate study reported a significant reduction in autograft reinfection rate when combined with BMAC (<jats:italic>P<\/jats:italic>\u2009=\u20090.009). Major adverse events include two deep infections at injection site and one case of heterotopic ossification. Most studies note transient mild donor site discomfort and potential injection site discomfort attributed to needle size.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The current literature pertaining to use of BM\/BMAC for nonunion is extremely heterogeneous in terms of patient population and concomitant treatment modalities. While results are promising for use of BM\/BMAC with other gold standard treatment methodologies, the literature requires additional Level I data to clarify the impact of role BM\/BMAC in treating nonunion when used alone and in combination with other modalities.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of evidence<\/jats:title>\n                <jats:p>Level III.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00590-024-04048-9","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T23:03:22Z","timestamp":1722035002000},"page":"2871-2880","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Bone marrow aspirate and bone marrow aspirate concentrate: Does the literature support use in long-bone nonunion and provide new insights into mechanism of action?"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4826-5783","authenticated-orcid":false,"given":"Andrew J.","family":"Moyal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin W.","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M.","family":"Adelstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler J.","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua K.","family":"Napora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,26]]},"reference":[{"key":"4048_CR1","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1016\/j.injury.2011.04.016","volume":"42","author":"GM Calori","year":"2011","unstructured":"Calori GM, Giannoudis PV (2011) Enhancement of fracture healing with the diamond concept: the role of the biological chamber. 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Joshua K. Napora, M.D., has the following conflicts of interest that are not related to the submitted work: A-fix (stock or stock options); Bone Solutions (paid consultant); Smith & Nephew (paid consultant); Stryker (research support). All other authors report no conflicts of interests outside the scope of the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}