Allograft vs. Autograft Nonunion

Inclusion Criteria: * Patients 18 years or older * Long bone (tibia, femur, and humerus) nonunion appropriate for either study treatment: to be treated with bone graft harvested from a remote site or using reamer harvester (RIA) * Nonunion surgery to be performed at least five months after initial fracture fixation * Prior operative fixation of fracture * Radiographic apparent bone gap (RABG) of \>5cm Exclusion Criteria: * Patient that speaks neither English nor Spanish * Patients whose treatment plan includes local autograft only (available callus from the nonunion site or no planned bone graft) * Known active infection (defined as any clinical signs or symptoms of active infection, such as fevers, wound redness, warmth, swelling, induration or drainage, and abnormal while blood cell count, erythrocyte sedimentation rate, or C-reactive protein) being treated with antibiotics * Body mass index greater than 50 * Patients unlikely to follow-up due to homelessness, or planning follow-up at another institution * Prisoner