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Bone grafts are normally used for the treatment of bone defects and non-union fractures, and the most common donor site is the iliac crest. The reamer-irrigator-aspirator (RIA) is an innovative technology to obtain osseous particles during intramedullary reaming in femur fractures. Discarded RIA can provide abundant native bone marrow mesenchymal stem cells (BM-MSCs) compared to the iliac crest. Autograft obtained from the use of RIA shows osteogenic potential at least equal to the iliac crest autograft with less donor site morbidity. The disadvantages of using the iliac crest including small volume, invasive harvesting, and pain for the patient make RIA-harvested autograft bone preferable because it has good properties and is amenable for use as a sole alternative to the iliac crest graft or as a graft expander in conjunction with autologous iliac crest bone marrow aspirate.