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

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

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

Fracture Healing Essential Requirements Osteogenic cells

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

Fracture Healing Essential Requirements Osteogenic cells Osteoconductive matrix

Scaffold

Fracture Healing Essential Requirements Osteogenic cells Osteoconductive matrix Osteoinductive stimulus

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

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

Mechanical Environment

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

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?

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

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