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      The ‘diamond concept’ for long bone non-union management

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          Abstract

          Long bone non-union continues to be a significant worldwide problem. Since its inception over a decade ago, the ‘diamond concept’, a conceptual framework of what is essential for a successful bone healing response, has gained great acceptance for assessing and planning the management of fracture non-unions. Herein, we discuss the epidemiology of non-unions, the basic science of bone healing in the context of the diamond concept, the currently available results and areas for future research.

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          Osteoinduction, osteoconduction and osseointegration.

          T Albrektsson, C. Johansson (2001)
          Osteoinduction is the process by which osteogenesis is induced. It is a phenomenon regularly seen in any type of bone healing process. Osteoinduction implies the recruitment of immature cells and the stimulation of these cells to develop into preosteoblasts. In a bone healing situation such as a fracture, the majority of bone healing is dependent on osteoinduction. Osteoconduction means that bone grows on a surface. This phenomenon is regularly seen in the case of bone implants. Implant materials of low biocompatibility such as copper, silver and bone cement shows little or no osteoconduction. Osseointegration is the stable anchorage of an implant achieved by direct bone-to-implant contact. In craniofacial implantology, this mode of anchorage is the only one for which high success rates have been reported. Osseointegration is possible in other parts of the body, but its importance for the anchorage of major arthroplasties is under debate. Ingrowth of bone in a porous-coated prosthesis may or may not represent osseointegration.
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            Fracture healing: The diamond concept

            Peter Giannoudis, Thomas Einhorn, David Marsh (2007)
            Article 0 comments Cited 226 times – based on 0 reviews     Review now
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              Delayed union and nonunions: epidemiology, clinical issues, and financial aspects.

              David J Hak, Daniel Fitzpatrick, Julius A Bishop … (2014)
              Fracture healing is a critically important clinical event for fracture patients and for clinicians who take care of them. The clinical evaluation of fracture healing is based on both radiographic findings and clinical findings. Risk factors for delayed union and nonunion include patient dependent factors such as advanced age, medical comorbidities, smoking, non-steroidal anti-inflammatory use, various genetic disorders, metabolic disease and nutritional deficiency. Patient independent factors include fracture pattern, location, and displacement, severity of soft tissue injury, degree of bone loss, quality of surgical treatment and presence of infection. Established nonunions can be characterised in terms of biologic capacity, deformity, presence or absence of infection, and host status. Hypertrophic, oligotrophic and atrophic radiographic appearances allow the clinician to make inferences about the degree of fracture stability and the biologic viability of the fracture fragments while developing a treatment plan. Non-unions are difficult to treat and have a high financial impact. Indirect costs, such as productivity losses, are the key driver for the overall costs in fracture and non-union patients. Therefore, all strategies that help to reduce healing time with faster resumption of work and activities not only improve medical outcome for the patient, they also help reduce the financial burden in fracture and non-union patients. Copyright © 2014 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Peter V. Giannoudis: 0044-113-3922750 , pgiannoudi@aol.com
                Journal
                Journal ID (nlm-ta): J Orthop Traumatol
                Journal ID (iso-abbrev): J Orthop Traumatol
                Title: Journal of Orthopaedics and Traumatology : Official Journal of the Italian Society of Orthopaedics and Traumatology
                Publisher: Springer International Publishing (Cham )
                ISSN (Print): 1590-9921
                ISSN (Electronic): 1590-9999
                Publication date (Electronic): 11 April 2019
                Publication date PMC-release: 11 April 2019
                Publication date (Print): December 2019
                Volume: 20
                Electronic Location Identifier: 21
                Affiliations
                ISNI 0000 0004 1936 8403, GRID grid.9909.9, Academic Department of Trauma & Orthopaedics, School of Medicine, , University of Leeds, ; Clarendon Wing, Floor D, Great George Street, Leeds General Infirmary, Leeds, LS1 3EX UK
                Article
                Publisher ID: 528
                DOI: 10.1186/s10195-019-0528-0
                PMC ID: 6459453
                PubMed ID: 30976944
                SO-VID: e36f2c78-a302-406d-990a-a5af4c177ff8
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 8 March 2019
                Date accepted : 20 March 2019
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Orthopedics
                Keywords: diamond concept,bone healing,long bone,non-union,mesenchymal stem cells
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: diamond concept, bone healing, long bone, non-union, mesenchymal stem cells

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