The IlluminOss® photodynamic bone stabilization system for pathological osteolyses and fractures of the humerus: indications, advantages and limits in a series of 12 patients at 24 months of minimum follow‐up

Abstract

Background Locked titanium nails are considered the reference treatment for metastatic bone lesions of the humerus in patients with aggressive histotypes, high risk of fracture or when estimated survival is lower than 6 months.Nevertheless, they are responsible for CT and MRI artifacts which interfere with postoperative radiotherapy and follow-up.The IlluminOss® is an intramedullary stabilization system which is introduced inside the humeral canal in a deflated state, and is then distended with a monomer which hardens after exposure to blue light,stabilizing the segment; it does not cause artifacts, allowing easier and more effective radiotherapy and follow-up. The aim of this study is to report our experience, indications, possible advantages and limitations of this stabilization system at 24 months of minimum follow-up in a series of 12 patients affected by pathological fractures or impending fractures of the humerus. Methods This is a retrospective case-series that included all patients who underwent surgery with the IlluminOss® Photodynamic Bone Stabilization System for pathological osteolyses and fractures of the humerus. Intraoperative and postoperative complications were valued. Results 12 patients and 13 procedures were included in the study. All surgeries were performed without intraoperative complications. No early postoperative complications were noted. The wounds healed in all cases and stitches were removed at two weeks from surgery, so the patients were able to perform chemotherapy after three weeks. All patients except one had a painless active range of motion which reached 90°.The VAS score was 7 preoperatively and 2.6 at one month from surgery. Pain relief was also associated to radiotherapy and chemotherapy. Unfortunately, two nail ruptures were reported at 4 and 12 months of follow-up. No artifacts were noted in the postoperative CT scans so the radiotherapy plans were easily performed without the need of dose compensation. Conclusions The IlluminOss® intramedullary stabilization system can provide primary stability in humeral fractures and impending fractures;the surgical technique is easy and minimally invasive.Moreover,it does not present artifacts at postoperative imaging,probably giving a better chance to perform prompt radiotherapy and chemotherapy.However, randomized clinical studies are necessary to verify its potential strength and if precocious adjuvant radio- and chemotherapy are associated to a reduction of the local progression rate.

A Novel Technique for Treatment of Peri-Implant Tibial Shaft Fracture with Pre-Existing Bimalleolar Ankle Fracture with a Combination of IlluminOss® Photodynamic Bone Stabilization System and Osteosynthesis

“…of radiolucent implants such as the minimally invasive Photodynamic Bone Stabilization System (PBSS; IlluminOss ® System) [3,7,8,12]. This concept has many advantages: Particularly the fact that the bone access, modalities is ideal for the treatment of fragility fractures or fractures with a compromised soft tissue situation [3,7].…”

“…unlike the metal implant, does not have to be chosen exactly in the axis of the medullary cavity, but an access adapted to the soft tissue situation [3,7,8,12]. In addition, the monomer remains drillable after the curing process, which potentiates its features for additional osteosynthesis fixation, if required [13].…”

Shoulder Surgery for Bone Tumors

“…Depending on the location and extent of the lesion, curettage and cement augmentation may be incorporated into the procedure as a means of enhancing disease local control and implant survival. A novel device composed of a liquid photodynamic monomer is an additional alternative providing strength and stability under rotational forces [13]. The advantage of long intramedullary devices in patients with metastatic disease is the protection of the entire bone in the event of further disease progression.…”

Patolojik Humerus Kırığı olan Erişkin Hastaların Tedavisi: Tek Merkez Deneyimi, Retrospektif Çalışma

“…Foto-dinamik stabilizayonda monomer enjekte edilen çiviler 436 NM ışığa maruz bırakılır ve monomer polimerize olarak çivi genişlemeyle birlikte stabilite sağlar. Bu reaksiyon ekzotermik olup yaklaşık 62 0 C ısı oluşuma neden olmaktadır 16 . Zoccali C. Ve ark.…”

“…Radyolusen yapıda olması, hastaların daha sonraki radyoterapilerinin uygulanmasında avantaj sağladığı belirtilmiştir. Fakat 2 hastada çivi rüptürü gelişmiş olup plak-vidayla revizyon cerrahisi ihtiyacı doğurmuştur 16 . Diğer bir tespit yöntemi de karbon İMÇ'lerdir.…”