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


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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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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


Classic knowledge

Cortex

Periosteum

Bone marrow

Soft tissue

Classic Knowledge

Components of Bone Formation


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

Fracture Healing………

But what are actually the essential requirements

???????


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

Fracture Healing Essential Requirements

Osteogenic cells


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

  • Non-hematopoetic, stromal cells

  • Exhibit multilineage differentiation capacity

  • Reside in diverse host tissues


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

Fracture HealingEssential Requirements

Osteogenic cells

Osteoconductive matrix


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

Scaffold


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

Fracture Healing Essential Requirements

Osteogenic cells

Osteoconductive matrix

Osteoinductive stimulus


Osteoinduction

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


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

Fracture Healing Essential Requirements

Osteogenic cells

Osteoinductive stimulus

Osteoconductive matrix

Favorable mechanical environment


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

Mechanical Environment


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

Mechanical Environment

  • Technique for fracture stabilization

  • Implants for fracture stabilization

  • Surgeon controlled


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

22 year old female


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

Stabilised with IM Nailing


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

5/12


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

Rotational deformity 30 degrees


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

Options of Treatment?


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

3/12


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

5/12


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

Diamond Concept…Issues?

A diamond is precious …

expensive…

MSc’s…………

Scaffold…….

Growth Factor?......


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

Efficacy –Results?

Literature?

MSC’s Scaffold Growth Factor

60%-89%

50%-88%

50%-80%


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

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?


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

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


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

MSC’s

Mechanical

Environment

Biology

GF

Scaffold

Conclusion

Conclusion

THANK

YOU!!

DIAMOND CONCEPT!!

Fracture Healing


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