Bone Healing: The Diamond Concept

The incidence of fracture non-union has been estimated to be as high as 10 %. The treatment of fracture non-union remains challenging even for the most experienced surgeons. The presence of a poor soft tissue envelope, deformity, avascular bone edges, reduced bone stock, low-grade infection and patient related co-morbidities are some of the important contributing factors that need to be addressed. Evaluation of the complexity of the non-union and formulating the appropriate pre-operative plan and treatment modality requires good understanding of the pathogenicity of this condition and having extensive surgical experience. The state of both the mechanical and biological environment, is thought to play a crucial role in the decision making process regarding revision surgery. Application of the so-called 'diamond concept' provides the optimum mechano-biological conditions for bone repair and should be considered in cases where difficulties to achieve union are anticipated.