The diamond concept for the treatment of long bone non-unuions and Bone defects.

Peter V Giannoudis MD, FRCSProfessor & ChairmanAcademic Department of Orthopaedic & Trauma SurgeryUniversity of Leeds, UK

Classic Knowledge

Components of Bone Formation

• Cortex

• Periosteum

• Bone marrow

• Soft tissue

Fracture Healing………

But what are actually the essential

requirements

???????

Fracture Healing Essential RequirementsOsteogenic cells

• Non-hematopoetic, stromal cells

• Exhibit multilineage differentiation capacity

• Reside in diverse host tissues

Fracture Healing Essential RequirementsOsteogenic cells

Osteoconductive matrix

Scaffold

Fracture Healing Essential Requirements

Osteogenic cellsOsteoconductive matrixOsteoinductive stimulus

OsteoinductionA process which supports the mitogenesis of

undifferentiated perivascular mesenchymal

cells leading to the formation of

osteoprogenitor cells with the capacity to form

new bone.

Dr Urist

Fracture Healing Essential Requirements

Osteogenic cellsOsteoinductive stimulusOsteoconductive matrixFavorable mechanical environment

Mechanical Environment

• Technique for fracture stabilization• Implants for fracture stabilization• Surgeon controlled

Mechanical Environment

22 year old female

Stabilised with IM Nailing

5/12

Rotational deformity 30 degrees

Options of Treatment?

3/12

5/12

Diamond Concept…Issues?

A diamond is precious … expensive…

MSc’s………… Scaffold……. Growth Factor?......

Efficacy –Results? Literature?

MSC’s Scaffold Growth Factor

50%-88% 50%-80% 60%-89%

Diamond Concept…Issues? A diamond is precious … expensive…However..!!

• Patients have undergone 1-2 … even more procedures !!!

• Soft tissues compromised?

• Healing potential ?

• Delayed process of healing?

• Additional cost implications?

Diamond Concept…Issues? A diamond is precious … expensive… but.. • Provides Optimum Biological

Conditions…

• Accelerates Fracture healing and consolidation…

• Facilitates Early Function..

• Early return to work..

This strategy should be considered in the

surgeon’s armamentarium

Fracture Healing

Biology MechanicalEnvironment

MSC’s

GF

Scaffold

Conclusion Conclusion

THANK YOU!!

DIAMOND CONCEPT!!