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

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 . Cortex Periosteum Bone marrow Soft tissue. Classic Knowledge.

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

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

  3. 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 HealingEssential 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

  13. 22 year old female

  14. Stabilised with IM Nailing

  15. 5/12

  16. Rotational deformity 30 degrees

  17. Options of Treatment?

  18. 3/12

  19. 5/12

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

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

  22. 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?

  23. 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

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

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