The diamond concept for the treatment of long bone non- unuions and Bone defects .
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Transcript of The diamond concept for the treatment of long bone non- unuions and Bone defects .
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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
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Classic Knowledge
Components of Bone Formation
• Cortex
• Periosteum
• Bone marrow
• Soft tissue
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Fracture Healing………
But what are actually the essential
requirements
???????
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Fracture Healing Essential RequirementsOsteogenic cells
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• Non-hematopoetic, stromal cells
• Exhibit multilineage differentiation capacity
• Reside in diverse host tissues
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Fracture Healing Essential RequirementsOsteogenic cells
Osteoconductive matrix
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Scaffold
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Fracture Healing Essential Requirements
Osteogenic cellsOsteoconductive matrixOsteoinductive stimulus
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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
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Fracture Healing Essential Requirements
Osteogenic cellsOsteoinductive stimulusOsteoconductive matrixFavorable mechanical environment
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Mechanical Environment
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• Technique for fracture stabilization• Implants for fracture stabilization• Surgeon controlled
Mechanical Environment
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22 year old female
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Stabilised with IM Nailing
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5/12
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Rotational deformity 30 degrees
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Options of Treatment?
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Diamond Concept…Issues?
A diamond is precious … expensive…
MSc’s………… Scaffold……. Growth Factor?......
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Efficacy –Results? Literature?
MSC’s Scaffold Growth Factor
50%-88% 50%-80% 60%-89%
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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?
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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
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Fracture Healing
Biology MechanicalEnvironment
MSC’s
GF
Scaffold
Conclusion Conclusion
THANK YOU!!
DIAMOND CONCEPT!!