Bone and Joint Diseases


Non-union fractures present a problem for the patient and surgeon. With most repair mechanisms in the body a fracture of a long or cranial bone, eg tibia, femur, humerus, mandible etc will generate a blood clot surrounding the fracture segment. The cells within the blood clot secrete various wound healing factors which contribute to a primary callus. There is ingrowth of cells such as osteoblasts that lay down the mesenchyme for the callus to not only develop and form for initial stabilisation but to mature into woven bone. This process may take generally 2-4 months depending upon the site of fracture and degree of stabilisation. If fractures are stabilised early and rigidly there may be less callus formation and consequently faster maturation to woven bone. 

In many cases the age of the patient has a significant influence on the ability to heal. This is because of a general lack of boney cellular ingrowth into the callus and a slower remodelling to woven bone. Indeed with any movement of the fracture there may be an ingrowth of fibroblasts which lay down collagen or scar tissue rather than bone. The fracture becomes mobile, non healed and subsequently defined as a non union. If the patient has co-existing disease such as diabetes or peripheral vascular disease, or the patient is a smoker then other factors only compound and increase the risk of a non union.

Non unions require more surgery, more damage to the vascular bed surrounding the bone and consequently become harder and harder to treat. The patient suffers pain because of the mobility of the fracture segments. It is rare for non unions in children because of the abundance of stem cells and bone marrow growth factors. We know that non unions require bone grafts to import cells and growth factors to the defect as well as more fixation.

Stem cells used for non-unions

If the surgeon can introduce more stem cells to the local area by direct application or infusion there is a greater chance that the non-union will become united. The stem cells can be harvested from either bone marrow or adipose tissue. In general it may seem disingenuous to remove bone in order to heal bone but the site of the iliac crest has long been used as a donor site for bone grafting. Nevertheless we would also use mesenchymal adipose stem cells harvested via mini liposuction from your abdominal wall and introduced to the surgical site as a potentiator of the healing mechanism. Depending upon the size of the defect we would recommend a certain amount of fat to be harvested or combined with the bone graft. In general the bone graft acts as scaffold for the stem cells to grow into and become osteoblasts. As they develop and lay down callus then other cells called osteoclasts also develop and the callus matures into woven bone and not a non-union.

The use of hyperbaric therapy with at least 10 treatments is mandatory. Indeed we would advise the beneficial effects of at least 20 treatments if the non-union has a large gap or there are associated medical reasons for why the patient has a non-union.


The diagnosis and treatment of non-unions can be challenging for the orthopedic or craniofacial surgeon. While the use of stem cells has not supplanted conventional therapy with debridement and bone grafting  we know that the mechanism of stem cells enhances the tissue repairing effect and there are many positive studies that are published.

At we pride ourselves on ensuring patients know the team diagnosing and conducting their stem cell therapy. Professor Russell Vickers is the lead specialist, working within a team of specialist surgeons and doctors.

Important questions that patients should ask of any treating clinicians and facility:

  • Are my treating doctors specialist surgeons/doctors and stem cell experts?
  • How many publications and research based studies have they published in peer reviewed journals?
  • Can they augment stem cell therapy with the known benefits of adjunctive therapy? is Europes premier stem cell organisation guided by evidence based medicine and clinical research.

Our founding director, Professor Russell Vickers PhD, MDsc, M Med, MA, FFPM (ANZCA) is an Australian and New Zealand board registered surgeon with over 100 publications, books and thousands of invited lectures and presentations on stem cells, pain, peptide synthesis and biochemistry. Professor Vickers is the leader of a family team of surgeons assisting him including Dr Peter Vickers, MD, FRCS (Edinburgh), FRACDS, Dr Richard Vickers, MD, FRCS (England, Glasgow, Ireland), FRACDS (OMS) and Dr Jessica Vickers, MD, MCOM, BA/BN as co-ordinator.

This medical summary has been written by Professor Vickers and his family team of specialist consultants.

It has been written by medically qualified writers.

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