Diamond concept for treatment of nonunions and bone defects

Nonunions represent a very heterogeneous, rare and sometimes very complex disease picture. The causes, localization and degree of expression show a very high variability, which makes it difficult to establish uniform treatment standards. Nevertheless, the process of bone healing is subject to some essential factors, which should be ensured for a successful treatment. Over the years these factors have been better researched and were taken into consideration for the diamond concept, which was first published by Giannoudis et al. in 2007. This provides the physician with a concept that does not neglect the heterogeneity of the disease picture and is an aid to decision making for the treatment regimen in individual cases in order to guarantee the best biological and mechanical conditions. The diamond concept is nowadays widely used and many studies have already demonstrated a successful application. It must be understood as a framework, in which the various treatment options available (bone substitute materials, mesenchymal stem cells, osteosynthesis procedures etc.) are incorporated into the individual factors and therefore provides the physician with a certain freedom of choice in the selection of tools. Additionally, it is not a rigid corset and subject to medical scientific progress in its factors, so that it is exciting to see which new developments will be incorporated in the future.