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Review
. 2019 Apr 11;20(1):21.
doi: 10.1186/s10195-019-0528-0.

The 'diamond concept' for long bone non-union management

Paul Andrzejowski  1 , Peter V Giannoudis  2
Affiliations
Review

The 'diamond concept' for long bone non-union management

Paul Andrzejowski et al. J Orthop Traumatol. .

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.

Keywords: Bone healing; Diamond concept; Long bone; Mesenchymal stem cells; Non-union.

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Conflict of interest statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this review.

Figures

Fig. 1
Fig. 1
Illustration of the ‘diamond concept’ of bone healing
Fig. 2
Fig. 2
Diagrammatic representation of fracture haematoma composition. Key: IL interleukin, MCP monocyte chemoattractive protein, M-CSF monocyte colony-stimulating factor, BMP bone morphogenic protein, PDGF platelet-derived growth factor, VEGF vascular endothelial growth factor, RANKL receptor activator of nuclear factor kappa-B ligand, OPG osteoprotegerin, SOST sclerostin (Adapted from Walters et al. [34] used with permission)
Fig. 3
Fig. 3
Diagrammatic representation of ossification: a Intramembranous ossification. Osteoinductive mediators induce osteogenic MSCs to differentiate into osteoblasts, which lay down osteoid (collagen-1 rich); this mineralises to form an ossification centre, whence mineralisation extends. There is terminal differentiation into osteocytes, becoming entombed in the bone matrix. b Endochondral ossification. Osteoinductive mediators induce osteogenic MSCs to differentiate into chondrocytes; a cartilage matrix is secreted which forms the template for endochondral bone formation. Chondrocytes then undergo hypertrophic differentiation and mineralise the surrounding matrix. They eventually undergo apoptosis—resulting in vascular invasion. Invading blood vessels convey osteoblasts which form bone on the cartilage template [46]
See this image and copyright information in PMC

References

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