Abstract
Distal femoral non-union presents significant challenges, often requiring complex treatment strategies to achieve bone healing. In this case, a young male patient with an open fracture of the distal femur developed an atrophic non-union, 9 months after initial fixation. The patient underwent surgical intervention with debridement, leading to a 2.2 cm bone defect and placement of a cylindrical synthetic bone graft (b.Bone), combined with bone marrow aspirate concentrate. This approach aimed to provide structural support and enhance biological healing. The choice of the cylindrical graft was due to its optimal fit and support for the anterior femoral cortex. Postoperative outcomes were favourable, with successful bone healing, confirmed radiologically, and restoration of function. This case demonstrates the potential of synthetic bone substitutes augmented with biological agents as a promising alternative to traditional grafts in managing complex non-unions.