1. Peter V Giannoudis MD, FRCS Professor & Chairman
The diamond concept for the treatment of long bone non-unuions and Bone defects.
Peter V Giannoudis MD, FRCS
Professor & Chairman
Academic Department of Orthopaedic & Trauma Surgery
University of Leeds, UK

2. Components of Bone Formation
Classic Knowledge
Components of Bone Formation
Cortex
Periosteum
Bone marrow
Soft tissue

3. But what are actually the essential requirements
Fracture Healing………
But what are actually the essential requirements
???????

4. Fracture Healing Essential Requirements
Osteogenic cells

5. Non-hematopoetic, stromal cells
Exhibit multilineage differentiation capacity
Reside in diverse host tissues

6. Fracture Healing Essential Requirements
Osteogenic cells
Osteoconductive matrix

7. Scaffold

8. Fracture Healing Essential Requirements
Osteogenic cells
Osteoconductive matrix
Osteoinductive stimulus

9. Osteoinduction
A 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

10. Fracture Healing Essential Requirements
Osteogenic cells
Osteoinductive stimulus
Osteoconductive matrix
Favorable mechanical environment

11. Mechanical Environment

12. Mechanical Environment
Technique for fracture stabilization
Implants for fracture stabilization
Surgeon controlled

16. 22 year old female

17. Stabilised with IM Nailing

18. 5/12

19. Rotational deformity 30 degrees

20. Options of Treatment?

25. 3/12

26. 5/12

27. Diamond Concept…Issues?
A diamond is precious …
expensive…
MSc’s…………
Scaffold…….
Growth Factor?......

28. Efficacy –Results? Literature? MSC’s Scaffold Growth Factor 50%-88%
50%-80%
60%-89%

29. 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?

30. This strategy should be considered in the surgeon’s armamentarium
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

31. THANK DIAMOND CONCEPT!! YOU!! Conclusion Conclusion Mechanical Biology
MSC’s
Mechanical
Environment
Biology GF
Scaffold
Conclusion
Conclusion
THANK
YOU!!
DIAMOND CONCEPT!!
Fracture Healing