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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.

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

Components of Bone Formation


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 HealingEssential 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

60%-89%

50%-88%

50%-80%


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


MSC’s

Mechanical

Environment

Biology

GF

Scaffold

Conclusion

Conclusion

THANK

YOU!!

DIAMOND CONCEPT!!

Fracture Healing


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