{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T04:11:50Z","timestamp":1789618310166,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Background: Despite stable fixation, aseptic tibial shaft nonunion represents a severe orthopedic complication. Teriparatide and adipose-derived stem-cell augmentation have been proposed as biological supports, but comparative clinical evidence remains limited. This study explored whether adding adjuvant therapies to reamed intramedullary nailing was associated with faster healing than nailing alone. Methods: We retrospectively reviewed 43 adults with aseptic tibial shaft nonunion treated at three level I trauma centers between 2017 and 2020. Patients underwent reamed intramedullary nailing alone (n = 15), nailing plus teriparatide (n = 15), or nailing plus adipose-derived stem-cell augmentation (n = 13). Group allocation was nonrandom and based on contraindications and patient acceptance; results were therefore interpreted as exploratory. Outcomes included time to tricortical radiographic healing, pain, radiographic healing scores over time, complications, ASAMI classification, and SF-12. Results: Baseline demographic and fracture characteristics were comparable across groups. Time to tricortical radiographic healing was shorter in the teriparatide group (87.46 \u00b1 6.34 days) and the adipose-derived stem-cell group (86.41 \u00b1 5.67 days) than in the nailing-alone group (99.71 \u00b1 4.29 days; p = 0.034). Pain, complication rates, ASAMI outcomes, and quality-of-life recovery did not differ significantly among groups at final follow-up. Conclusions: In this exploratory multicenter retrospective cohort, teriparatide and adipose-derived stem-cell augmentation were associated with shorter radiographic healing time after reamed intramedullary nailing for aseptic tibial shaft nonunion, but not with superior long-term functional outcomes. Because no comparator group treated with standard graft-based biological augmentation was included, the findings should be interpreted cautiously. Larger prospective studies or randomized controlled trials comparing these strategies with established graft-based approaches are needed to validate the present data.<\/jats:p>","DOI":"10.3390\/jfmk11020239","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:38Z","timestamp":1781661518000},"page":"239","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Biological Augmentation of Reamed Intramedullary Nailing for Aseptic Tibial Shaft Nonunion: An Exploratory Multicenter Retrospective Comparative Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3585-1000","authenticated-orcid":false,"given":"Michele","family":"Coviello","sequence":"first","affiliation":[{"name":"Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3669-189X","authenticated-orcid":false,"given":"Luigi","family":"Meccariello","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, AORN San Pio Hospital, 82100 Benevento, Italy"},{"name":"School of Medicine and Surgery, University of Doboj, 74000 Doboj, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rovere","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Caiaffa","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Di Venere Hospital, 70131 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Rollo","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Liuzza","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Ronga","sequence":"additional","affiliation":[{"name":"Orthopaedic and Trauma Operative Unit, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, San Giuseppe Da Copertino Hospital, 73043 Copertino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-6785","authenticated-orcid":false,"given":"Amarildo","family":"Smakaj","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Lucia","family":"Mancini","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Di Venere Hospital, 70131 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Colella","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics, Children\u2019s Hospital Giovanni XXIII, 70126 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8596-2422","authenticated-orcid":false,"given":"Giuseppe","family":"Maccagnano","sequence":"additional","affiliation":[{"name":"Orthopaedics Unit, Department of Clinical and Experimental Medicine, Faculty of Medicine and Surgery, University of Foggia, Policlinico Riuniti di Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Antonova, E., Le, T.K., Burge, R., and Mershon, J. 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