Regenerative Surgery of the Nonunion of Metacarpals and Phalanges: Amniotic Membrane and Bone Micro-Grafts as a Novel Treatment Approach

<b>Background/Objectives</b>: Atrophic nonunion presents a significant challenge in hand surgery, often resulting in chronic pain and functional disability. Traditional surgical treatments such as bone grafting and internal fixation may be insufficient. This study evaluates the feasibility, safety, and preliminary effectiveness of a regenerative-first surgical protocol that combines autologous bone micro-grafts with a fresh human amniotic membrane to create a biologically active regenerative chamber. <b>Methods</b>: A total of 8 patients (6 males, 2 females; age range: 22-56 years) with an atrophic nonunion of metacarpals and phalanges were treated using a regenerative-first surgical approach. Autologous bone was harvested from the iliac crest and mechanically disaggregated via Rigenera^® technology to obtain micro-grafts enriched with osteoprogenitor cells and extracellular matrix fragments. These were applied to the bone defect and wrapped in a fresh amniotic membrane, creating a biologically active chamber. Fixation was achieved using low-profile plates or screws, and all patients underwent early protected mobilization. <b>Results</b>: Radiographic consolidation was achieved in all patients within 2 months postoperatively. Functional outcomes at final follow-up demonstrated excellent or good results in Total Active Motion (TAM), with grip and pinch strength within normative ranges and minimal residual pain. <b>Conclusions</b>: This preliminary series suggests that combining autologous bone micro-grafts with an amniotic membrane in a regenerative surgical protocol is a promising strategy for managing atrophic nonunion in the hand. The approach was associated with rapid consolidation and excellent functional recovery. Further research with larger, controlled cohorts is warranted to validate efficacy and define standardized indications and techniques.