A 40-year-old male has a closed tibial shaft fracture treated with intramedullary nailing. Six months post-op, X-ray shows no callus and the fracture gap remains visible. Screw breakage is noted. According to the Diamond Concept of fracture non-union management, which FOUR factors must be optimised?
- A Patient compliance, surgeon skill, implant choice, and physiotherapy
- B Vascularity, mechanical stability, growth factors/cells, and bone scaffold ✓
- C Infection control, pain management, nutritional status, and hormonal optimisation
- D Cortical contact, periosteal stripping reversal, intramedullary pressure, and callus distraction
Correct answer: B. Vascularity, mechanical stability, growth factors/cells, and bone scaffold
Explanation
The Diamond Concept of non-union management, proposed by Giannoudis et al., defines four essential elements for successful bone healing: (1) osteogenic cells (bone marrow aspirate concentrate or autograft), (2) osteoinductive signals (growth factors like BMPs), (3) osteoconductive scaffold (bone graft substitute), and (4) mechanical stability (stable fixation). Vascularity underpins the biological environment. Addressing all four elements simultaneously gives superior results compared to treating each in isolation.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.