Diamond concept

Fracture healing: the diamond concept

Giannoudis PV, Einhorn TA, Marsh D Injury 2007 · PMID 18224731 · doi:10.1016/s0020-1383(08)70003-2

Question

What are the essential requirements for successful fracture healing, and how should they guide treatment of nonunion?

Design

Narrative review and conceptual framework from UK (Leeds) and US authors.

Patients

Fracture healing and nonunion in general.

Intervention

Framework: osteogenic cells, osteoconductive scaffold, osteoinductive growth factors and mechanical stability (with vascularity and host factors)

Comparison

Not applicable

Primary outcome

Not applicable (conceptual model)

Key result

Proposes that successful healing needs all four elements together, so nonunion treatment should identify and address each deficient element rather than relying on a single adjunct.

Limitations

Expert opinion rather than primary data; the framework is descriptive and not itself validated in trials.

Impact on practice

Widely taught model for planning nonunion surgery (polytherapy: stable fixation plus graft, cells and growth factors) and a staple of FRCS basic science viva questions.