the diamond concept for the treatment of long bone non-unuions and bone defects. peter v giannoudis...
TRANSCRIPT
The diamond concept for the treatment of long bone non-unuions and Bone defects.
Peter V Giannoudis MD, FRCS
Professor & ChairmanAcademic Department of Orthopaedic & Trauma Surgery
University 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 cells
Osteoconductive matrix
Osteoinductive 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 cells
Osteoinductive stimulus
Osteoconductive matrix
Favorable 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 Mechanical
Environment
MSC’s
GF
Scaffold
Conclusion Conclusion
THANK YOU!!
DIAMOND CONCEPT!!