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. 2017 Nov 13;7:15463. doi: 10.1038/s41598-017-15451-0

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© The Author(s) 2017

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Clinical cases. (A) A 38-year-old man had a right femoral shaft fracture, which was treated close reduction and intramedullary nail fixation. For the next 5 years, the fracture did not heal. The fracture line was still obvious in radiograph. The patient needed a pair of crutches to facilitate walking and suffered from pain during walking. (B–D) β-TCP granules (white) served as filtration materials in the inner box of SECCS. Bone marrow circulated in the sealed circulatory pipe of the SECCS for 10 min. Then MSC/β-TCP composites (red granules) had been prepared. (E) After exposure of nonunion, the instable fracture was stabilized with a plate. The MSC/β-TCP composites, rather than autologous bone, were implanted into and around interfragmental gap. (F) Immediate post-operative image: the unstable fracture was fixed by a plate and grafted with MSC/β-TCP composite only. (G) Six months postoperatively, the nonunion completely healed, and most β-TCP particles had degraded. (H) The function of the injured limb was fully restored. Patient went back to work. (Ja) A 48-year-old female suffered a fresh fracture of right tibial plateau. (Jb) She underwent open reduction and internal fixation. Intraoperatively, a critical-size cavity formed after fracture reduction (white arrows). The defect was grafted with MSC/β-TCP composite. (Jc) After 3 months, the fracture healed. (Ka) A 17-year-old male was diagnosed as right humerus fibroma. (Kb) He was treated with tumor resection, internal fixation, and MSC/β-TCP composite graft. (Kc) Six months postoperatively, β-TCP granules degraded completely and graft site was restored by newly forming bone.