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Nixon B, Stewart S, Crawford B, Temple T, Munera F, Jose J. Novel illuminoss photodynamic bone stabilization system: normal and post-operative complication imaging findings in the emergency setting. Emerg Radiol 2024; 31:381-390. [PMID: 38519744 DOI: 10.1007/s10140-024-02215-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Abstract
The mainstay orthopedic surgical technique for fracture fixation involves metal plates, screws, and rods. While these methods are effective, they exhibit high rates of complications within specific populations, particularly among patients with pathologic and insufficiency fractures. IlluminOss represents a novel photodynamic bone stabilization system, approved for use in multiple countries, that serves as an alternative to traditional fracture fixation approaches for patients experiencing pathologic, traumatic, and fragility fractures. Despite the initial success of the system in fostering fracture healing, no study has comprehensively examined the radiological attributes of the IlluminOss Stabilization system thus far. The emergency radiologist is often the first point of imaging identification and interpretation for patients presenting with suspected postoperative complications, requiring evolving knowledge of both expected and atypical appearances for novel surgical implants. This manuscript's objective is to delve into the design and clinical application of IlluminOss, scrutinize relevant normal imaging findings across various modalities, and delineate potential complications associated with the IlluminOss Stabilization system for traumatic, pathologic, and fragility fractures that are increasingly encountered in the emergency department setting.
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Affiliation(s)
- Bryan Nixon
- Department of Radiology, University of Miami, Miami, FL, 33136, USA.
| | - Sara Stewart
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Brooke Crawford
- Department of Orthopaedics, University of Miami, Miami, FL, 33136, USA
| | - Thomas Temple
- Department of Orthopaedics, University of Miami, Miami, FL, 33136, USA
| | - Felipe Munera
- Department of Radiology, University of Miami, Miami, FL, 33136, USA
| | - Jean Jose
- Department of Radiology, University of Miami, Miami, FL, 33136, USA
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Zhu KY, McNassor R, Hecht Ii CJ, Burkhart RJ, Nystrom LM, Kamath AF. Photodynamic bone stabilization for traumatic and pathologic fractures: a systematic review of utilization, complications, and patient-reported outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1269-1277. [PMID: 38376586 PMCID: PMC10980623 DOI: 10.1007/s00590-024-03833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION The photodynamic bone stabilization system (PBSS) was was developed in 2010, and in 2018 gained FDA approval in the United States. Given its relative novelty, our analysis sought to analyze the available literature exploring the indications, outcomes, and complications of the PBSS. METHODS We performed a systematic review (PROSPERO registration of study protocol: CRD42022363065, October 8th, 2022). PubMed, EBSCOHost, and Google Scholar electronic databases were queried to identify articles evaluating PBSS in the treatment of pathologic or traumatic fractures between January 1 2010 and 15 October 2022. The quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies tool. RESULTS Our initial search yielded 326 publications, which were then screened for appropriate studies that aligned with the purpose of our review. A total of thirteen studies, comprising seven case series, four case reports, and two cohort studies. The total sample size of the included studies consisted of 345 patients, with 242 females (70%) and 103 males (30%). The implants were most commonly utilized in the humerus (41%), radius (12%), and metacarpal (12%). The most common complications were related to broken implants (5%) and dislocation (1%). Most studies reported complete fracture healing and return of full strength and range of motion. CONCLUSION Despite being a relatively novel technology, PBSS appears to be a viable option for fracture stabilization. Most studies included in our analysis reported complete fracture healing and return of function with minimal complications.
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Affiliation(s)
- Kevin Y Zhu
- Department of Orthopedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Ryan McNassor
- Department of Orthopedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht Ii
- Department of Orthopedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Robert J Burkhart
- Department of Orthopedic Surgery, University Hospitals, Cleveland, OH, 44195, USA
| | - Lukas M Nystrom
- Department of Orthopedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Atul F Kamath
- Department of Orthopedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Vemu SM, Farii HA, Bird JE, Lin PP, Lewis VO, Patel SS. The Use of Photodynamic Bone Stabilization to Tamponade Bleeding in a Pathologic Humeral Shaft Fracture: A Case Report. J Orthop Case Rep 2023; 13:137-143. [PMID: 37753123 PMCID: PMC10519327 DOI: 10.13107/jocr.2023.v13.i09.3906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypervascular tumors such as renal and thyroid carcinoma have a significant risk of intraoperative bleeding. To help mitigate bleeding, interventional preoperative embolization is traditionally used; however, it is success is highly variable. This is the first case report to discuss using expandable balloon implants with a minimally invasive approach to achieve fracture fixation and tamponade acute intraoperative bleeding. Case Report A 48-year-old male with clear-cell renal cell carcinoma presented with a left humeral shaft pathologic fracture. The patient was scheduled to undergo open biopsy, curettage of tumor, and fracture fixation with an intramedullary device. Intraoperatively, during open biopsy and curettage, brisk bleeding was encountered, which ceased after inserting an intramedullary photodynamic bone stabilization implant (IlluminOss). The implant's balloon expanded to the diameter of the humerus allowing for tamponade, fracture stability, and a minimally invasive approach. Conclusion We present a possible intraoperative option for achieving control of bleeding in pathologic long bone fractures by deploying a photodynamic stabilization device. The method described can have applications in specific patients and obviate the need for pre-operative embolization for highly vascular tumors due to the implant's ability to create tamponade within the bone.
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Affiliation(s)
- Sree M Vemu
- Department of Orthopedic Surgery, Houston Methodist, 6445 Main St #2500, Houston, Texas 77030, United States
| | - Humaid Al Farii
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Justin E Bird
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Patrick P Lin
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Valerae O Lewis
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Shalin S Patel
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
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Krumme JW, MacConnell AE, Adams BW, Jelinek JJ, Henshaw RM. Radiolucent Implants for Fixation of Impending and Pathologic Fractures. Orthopedics 2022; 45:e115-e121. [PMID: 35201938 DOI: 10.3928/01477447-20220217-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Radiolucent implants offer theoretical advantages of increased ability to evaluate the fracture site for healing and recurrence and potentially less effect on radiation treatment, avoiding scatter. Their clinical utility and outcomes have yet to be proven in a well-designed randomized trial or large cohort study, although studies based on other indications have shown relative safety and they are approved by the US Food and Drug Administration for treatment of pathologic fractures. Further research is necessary to better understand when and how these implants should be implemented in practice. [Orthopedics. 2022;45(3):e115-e121.].
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Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review. Case Rep Med 2020; 2020:8408943. [PMID: 33110432 PMCID: PMC7582063 DOI: 10.1155/2020/8408943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient's quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.
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Van Oijen GW, Vegt PA, Hagenaars T, Van Lieshout EMM, Verhofstad MHJ. Outcome after treatment of distal radius fractures in the elderly using the IlluminOss ® System. Eur J Trauma Emerg Surg 2020; 47:1129-1136. [PMID: 31950234 PMCID: PMC8321991 DOI: 10.1007/s00068-019-01289-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/17/2019] [Indexed: 11/09/2022]
Abstract
Purpose Distal radius fractures are very common and account for approximately 17% of all fractures treated. Multiple treatment methods are available to treat these fractures, both operative and nonoperative. This study aimed at evaluating the functional and clinical outcomes after treatment of distal radius fractures with the IlluminOss® System in adult patients. Methods A retrospective case series was performed in a single-level two-trauma center. All consecutive adult patients with a distal radius fracture, treated with the IlluminOss® System between 01 August 2012 and 15 August 2015, were included in this study. Baseline patient characteristics and clinical data were retrospectively extracted from the medical records. Radial inclination, volar/dorsal tilt, ulnar variance, and radial length were measured on the latest available standard radiographs. In addition, patients were prospectively subjected to physical examination and were asked to complete the Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Wrist Evaluation, and Short Form-36 questionnaires. Results Twenty-six patients with 31 distal radius fractures were included. The median age at time of trauma was 77 years and 96% were females. Five patients developed a total of seven complications. Due to persisting pain one reoperation was performed, removing a small prominent part of the implant. Both patient-reported outcome scores and radiographic results were good to excellent. Conclusions The IlluminOss® System is a feasible option to treat distal radius fractures with seemingly good clinical and functional outcome. One out of seven complications required surgical intervention. These outcomes justify more detailed prospective research.
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Affiliation(s)
- Guido W Van Oijen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Paul A Vegt
- Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Tjebbe Hagenaars
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Van Oijen GW, Croughs PD, Hagenaars T, Verhofstad MHJ, Van Lieshout EMM. Antimicrobial Effect Of Visible Blue Light Used In A Minimally Invasive Intramedullary Fracture Stabilization System. J Bone Jt Infect 2019; 4:216-222. [PMID: 31700769 PMCID: PMC6831804 DOI: 10.7150/jbji.35629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/06/2019] [Indexed: 01/02/2023] Open
Abstract
Introduction: Since 2009, the IlluminOss® System is being used as an intramedullary fracture treatment. The system is characterized by the use of blue light to polymerize liquid monomer after its infusion in a polyethylene terephthalate balloon. Very few infections of the material have been observed, which might be explained by the possible antimicrobial side-effect of the blue light used in this intramedullary fracture stabilization system. This study aimed to assess this antimicrobial (side-)effect on S. aureus. Methods: A suspension of 1.5 x 103 CFU/ml of 8325-4 S. aureus was placed into five, custom made, black delrin cylinders. The implant was placed into the cylinders and the light source was activated for 200, 400, 600, 800, or 1,000 seconds. 100 µL of the light exposed suspension was grafted on blood agar and placed in a 35 degrees Celsius incubator for 24 hours. Colonies on each agar plate were counted and compared to the control plates (no blue light exposure). Results: The control plates showed a mean of 85 ± 15 colonies per plate. A statistically significant decrease was observed after 600 seconds of exposure time; mean colony count of 63 ± 4 (p <0.05). The absolute reduction was 24 ± 14 after 600 seconds exposure time. At 800 and 1,000 seconds, no statistically significant reduction was found compared with the control plates (means 72 ± 10 and 83 ± 14 colonies, respectively). Conclusions: In this study only a temporary reduction of S. aureus was observed. If future research regarding the antimicrobial characteristics of blue light used in the IlluminOss® System is desired, it should focus on the need for oxygen and its availability and the dose and manner of applying the light.
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Affiliation(s)
- Guido W Van Oijen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter D Croughs
- Department of Microbiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tjebbe Hagenaars
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Pathological fractures of long tubular bones are stabilized with conventional implants. Essentially, plates and intramedullary nails are used for stabilization and are two different techniques, which compete with each other with respect to the surgical treatment. A large number of such means of osteosynthesis are commercially available but are primarily focused on acute fractures in otherwise biologically healthy bones. The pathological fracture or the treatment of impending pathological fractures due to metastatic osteolysis differs from the treatment of healthy bones in some fundamental aspects. The characteristics of pathological fractures make the development of new technologies that meet the specific needs of both the patient and the surgeon desirable. A new approach in treatment is stabilization of internal long bone fractures by the use of a cylindrical balloon implant, which is introduced into the bone via a small proximal or distal hole and then filled and expanded to a much larger diameter with a liquid monomer. The curing process is initiated with the application of blue light forming a rigid implant by polymerization (IlluminOss™). Many of the well-known disadvantages of conventional implants can be eliminated with this technology. Specifically, with respect to the irregular shape of the natural medullary canal it is possible to completely fill the medullary canal of the tubular bone. The filling of the canal provides torsional stability without the use of interlocking screws. Similarly, the use of the balloon technique enables minimally invasive surgery and furthermore permits the additive use of conventional metallic plates whenever necessary. The new balloon techniques show high primary stability in the treatment of pathological shaft fractures. In particular cases, the addition of a supplemental plate osteosynthesis is recommended.
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Pesch S, Gromer A, Beirer M, Huber-Wagner S, Biberthaler P, Kirchhoff CM. Augmentation of simultaneous acetabular and femoral neck fracture in osteogenesis imperfecta using photodynamic bone stabilization - A case report. Trauma Case Rep 2019; 24:100200. [PMID: 31872019 PMCID: PMC6911912 DOI: 10.1016/j.tcr.2019.100200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Surgical fracture treatment in patients suffering from "osteogenesis imperfecta" (OI) is challenging and often results in unsatisfactory fixation of implants due to altered bone quality. Even the use of locking plates bears a residual risk to develop a loss of reduction leading to secondary fracture dislocation. However, the augmentation with an intramedullary photodynamic bone stabilization system (PBS) (e.g. Illuminoss®) may increase bone stability and allow for a sufficient anchorage of established implants even in OI patients. Case presentation We report the case of a 41-year-old male patient with the diagnosis of OI. He sustained a medial femoral neck fracture (Garden type IV, Pauwels type III) and a fracture of the acetabulum (AO-Type 62-B.3) - both right-sided - after a blunt trauma during a bicycle accident. The medial femoral neck fracture was subsequently surgically treated to preserve the femoral head. After augmentation of the proximal femur with the PBS, a Dynamic Hip Screw (DHS) was implanted. After a short recovery, the acetabular fracture was surgically treated by intramedullary augmentation and locking plate fixation.The patient was discharged seven days after the surgical intervention of the acetabular fracture. Partial weight-bearing activities of the right lower extremity were performed on crutches for 6 weeks. The patient was able to do his outpatient rehabilitation program without any complications. He returned to work eight weeks after surgery. After a follow-up of four months, the patient presented full weight-bearing without assistance. No physical complaints were reported 14 months after surgery (Harris Hip Score 90). Conclusion To the best of our knowledge, we report the augmentation with a photodynamic bone stabilization system of internal fixation techniques in an OI patient with fractures of the femoral neck and the acetabulum for the first time. This advanced surgical procedure shows the high potential of intramedullary photodynamic bone stabilization in patients with minor bone quality.
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Affiliation(s)
- Sebastian Pesch
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Gromer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Marc Beirer
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Stefan Huber-Wagner
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Chlodwig M Kirchhoff
- Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
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Gausepohl T, Gick S, Heck S, Pennig D. [Osteoporotic bone fractures: intramedullary augmentation and hybrid osteosynthesis]. Unfallchirurg 2019; 122:596-603. [PMID: 31073703 DOI: 10.1007/s00113-019-0660-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The increasing number of people who are living longer and have a far more active lifestyle is inevitably associated with greater numbers of fractures. Stabilization of these fractures in older patients with plates and screws is complicated by fragile bone substance, especially in osteoporotic bone, since osteosynthesis with a conventional plate depends exclusively on the holding power of the screws. Therefore, treatment requires new stabilization technologies designed for these specific tasks. A small diameter polyethylene terephthalate (PET, Dacron®) balloon is delivered in a minimally invasive fashion and placed within the canal, transversing the fracture. Once positioned, the balloon is expanded with a liquid monomer to fill the medullary canal. The liquid monomer is then rapidly cured using visible blue light, forming a patient-customized intramedullary implant that stabilizes the entire length of the bone in contact with the implant. The described intramedullary implant can be easily drilled in any position or location, providing a substantial increase in screw holding power. Thus, a major advantage of the technique is the possibility to augment the newly formed balloon "nail" with a conventional plate and screws at the primary stabilization or at any later time.
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Affiliation(s)
- Thomas Gausepohl
- Zentrum Unfallchirurgie und Orthopädie, Standort Wetzlar (Lehrkrankenhaus der Universität Gießen), Lahn-Dill-Klinken, Wetzlar, Deutschland. .,Zentrum Unfallchirurgie und Orthopädie, Standort Dillenburg (Lehrkrankenhaus der Universität Marburg), Lahn-Dill-Klinken, Dillenburg, Deutschland. .,, Ludwigstr. 72, 35392, Gießen, Deutschland.
| | - Sascha Gick
- Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie, St. Vinzenz Hospital Köln (Lehrkrankenhaus der Universität zu Köln), Köln, Deutschland
| | - Steffen Heck
- Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie, St. Vinzenz Hospital Köln (Lehrkrankenhaus der Universität zu Köln), Köln, Deutschland
| | - Dietmar Pennig
- Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie, St. Vinzenz Hospital Köln (Lehrkrankenhaus der Universität zu Köln), Köln, Deutschland
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Oikonomidis S, Alabsi A, Ashqar G, Graf M, Sobottke R. Intramedullary Stabilization of Pubic Ramus Fractures in Elderly Patients With a Photodynamic Bone Stabilization System (IlluminOss). Geriatr Orthop Surg Rehabil 2019; 10:2151459318824904. [PMID: 31041113 PMCID: PMC6484244 DOI: 10.1177/2151459318824904] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction: A photodynamic bone stabilization system (PBSS) is a percutaneous operating method that provides intramedullary stabilization. The purpose of the study was to assess the clinical and radiological outcome after treatment of pubic ramus fractures with the PBSS. Materials and Methods: In a retrospective study, patients with osteoporotic pubic ramus fractures were included. The patients were treated with the PBSS in a percutaneous method. In the routine follow-up examination, pain was measured with the visual analog scale (VAS) and the type of mobilization was verified. Computer tomography of the pelvis was carried out in the follow-up examination (mean of 7.5 months after surgery) to investigate bone healing. Results: A total of 32 patients (25 females and 7 males) were included in the study. The average hospital stay was 16.5 ± 7.9 days (range: 5-37 days) and the mean operation time was 116.8 ± 47.1 minutes (range: 33-255 minutes). Two cases of wound infections and 1 case of misplacement of the PBSS implant with revision surgery have been documented. The mean VAS score for pelvic/hip pain at the day of inpatient discharge was 4.4 ± 1.4 (range: 2-7). A total of 25 patients could attend the follow-up examination 7.5 ± 1.7 months (range: 6-14) after the procedure, reporting a mean VAS for pelvic/hip pain of 3.0 ± 2.2 (range: 0-8). A total of 11 patients could walk without an orthopedic walking device, 7 patients needed underarm crutches, 6 patients used a walker-rollator, and 1 patient was immobilized. Consolidated pubis ramus fractures were described in 24 (96%) cases. Discussion: The results of our study reveal adequate clinical and radiological outcomes after treatment of osteoporotic pubic ramus fractures with the PBSS. This is the first study investigating the outcome after treating pubic ramus fractures with the PBSS. Conclusion: Based on our findings, the PBSS is an alternative to known techniques for the stabilization of the pubic ramus.
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Affiliation(s)
- Stavros Oikonomidis
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Rhein-Mass Klinikum, Wuerselen, Germany
| | - Ahmad Alabsi
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Ghazi Ashqar
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Markus Graf
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany
| | - Rolf Sobottke
- Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany.,Department of Orthopaedics and Trauma Surgery, Rhein-Mass Klinikum, Wuerselen, Germany
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12
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Vegt P, Verbruggen J, Gausepohl T, Vroemen JP, Schafer W, Pennig D, Muir JM. The Photodynamic Bone Stabilization System in the Treatment of Humerus Fractures: A Prospective Clinical Trial. Cureus 2018; 10:e2809. [PMID: 32175197 PMCID: PMC7053794 DOI: 10.7759/cureus.2809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Fractures of the proximal humerus are among the most common long-bone fractures and present unique challenges to surgeons. Traditional internal fixation methods, such as intramedullary nails, are associated with drawbacks such as an inability to fully fill the trabecular space and a limited ability to utilize supplemental hardware in many cases. We evaluated the safety and effectiveness of a novel fracture fixation device that utilizes a light-cured monomer to stabilize the fracture in a cohort of patients suffering from humerus fractures. Methods We prospectively collected data from patients being treated surgically for humerus fractures. Fractures were treated using the photodynamic bone stabilization system (PBSS) consisting of a balloon and light-cured monomer. Patients were evaluated at 7-14, 30, 60, 90, 180, and 360 days post-procedure. Primary outcomes included normal and complete radiographic fracture healing. Secondary outcomes included pain (via visual analog scale), function (via the disability of the arm, shoulder, and hand (DASH) and constant shoulder scales), and the rate of complications. Results A total of 33 patients were included in the intent-to-treat analysis (mean age: 76.6 yrs). Of these patients, 88% demonstrated normal radiographic healing at their 90-, 180-, and 360-day visits. Complete radiographic healing was observed in 81%, 88%, and 96% of patients at 90, 180, and 360 days, respectively. Pain scores decreased significantly at day seven when compared with baseline (28.2+20.9 vs.53.6+32.2, p<0.001) and continued to decrease at the 90-day (24.7+15.5, p<0.001), 180-day (17.8+12.5, p<0.001) and 360-day (6.6+6.7, p<0.001) evaluations. DASH scores demonstrated statistically significant improvements over baseline (65.5+31.5) at 90 (37.0+14.9, p<0.001), 180 (30.6+15.7, p<0.001), and 360 days (23.9+15.0, p<0.001) post-procedure. The procedure-related event rate was 36.4%, with 5 (11.4%) device-related adverse events reported at the one-year follow-up. Conclusions Our study demonstrates the ability of a novel internal fixation device to safely and effectively treat fractures of the humerus in the elderly population.
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Affiliation(s)
- Paul Vegt
- Surgery, Albert Schweitzer Hospital, Dordrecht, NLD
| | - Jan Verbruggen
- Surgery, University Hospital Maastricht, Maastricht, NLD
| | | | | | - Walter Schafer
- Clinic for Orthopedics, Kreiskrankenhaus Gummersbach, Gummersbach, DEU
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13
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Meijering D, Harsevoort GJ, Janus AJM, van Helden SH. Supracondylar femur fracture repair using IlluminOss in a patient with Osteogenesis Imperfecta type 4. J Orthop 2018; 15:663-665. [PMID: 29881216 DOI: 10.1016/j.jor.2018.05.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/07/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- D Meijering
- Department of Orthopedic Surgery and Traumatology, Isala Klinieken, Zwolle, The Netherlands
| | - G J Harsevoort
- Department of Orthopedic Surgery and Traumatology, Isala Klinieken, Zwolle, The Netherlands
| | - A J M Janus
- Department of Orthopedic Surgery and Traumatology, Isala Klinieken, Zwolle, The Netherlands
| | - S H van Helden
- Department of Orthopedic Surgery and Traumatology, Isala Klinieken, Zwolle, The Netherlands
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14
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Hedgeland MJ, Martin Clark A, Ciani MJ, Michalek AJ, Kuxhaus L. A Proximally-Adjustable Variable Length Intramedullary Nail: Ex Vivo Quasi-Static and Cyclic Loading Evaluation. J Med Device 2017. [DOI: 10.1115/1.4037260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An adjustable-length intramedullary (IM) nail may reduce both complications secondary to fracture fixation and manufacturing costs. We hypothesized that our novel nail would have suitable mechanical performance. To test this hypothesis, we manufactured three prototypes and evaluated them in quasi-static axial compression and torsion and quasi-static four-point bending. Prototypes were dynamically evaluated in both cyclic axial loading and four-point bending and torsion-to-failure. The prototypes exceeded expectations; they were comparable in both quasi-static axial stiffness (1.41 ± 0.37 N/m in cervine tibiae and 2.30 ± 0.63 in cadaver tibiae) and torsional stiffness (1.05 ± 0.26 N·m/deg in cervine tibiae) to currently used nails. The quasi-static four-point bending stiffness was 80.11 ± 09.360, greater than reported for currently used nails. A length-variance analysis indicates that moderate changes in length do not unacceptably alter bone-implant axial stiffness. After 103,000 cycles of axial loading, the prototype failed at the locking screws, comparable to locking screw failures seen clinically. The prototypes survived 1,000,000 cycles of four-point bend cyclic loading, as indicated by a consistent phase angle throughout cyclic loading. The torsion-to-failure test suggests that the prototype has adequate resistance to applied torques that might occur during the healing process. Together, these results suggest that our novel IM nail performs sufficiently well to merit further development. If brought to market, this adjustable-length IM nail could reduce both patient complications and healthcare costs.
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Affiliation(s)
- Mark J. Hedgeland
- Mem. ASME Department of Mechanical and Aeronautical Engineering, Clarkson University, 8 Clarkson Avenue, Box 5725, Potsdam, NY 13699 e-mail:
| | - Alexander Martin Clark
- Department of Orthopaedic Surgery, Sharon Hospital, 50 Hospital Hill Road, Sharon, CT 06069 e-mail:
| | - Mario J. Ciani
- Department of Occupational Therapy, Clarkson University, 8 Clarkson Avenue, Box 5882, Potsdam, NY 13699 e-mail:
| | - Arthur J. Michalek
- Mem. ASME Department of Mechanical and Aeronautical Engineering, Clarkson University, 8 Clarkson Avenue, Box 5725, Potsdam, NY 13699 e-mail:
| | - Laurel Kuxhaus
- Mem. ASME Department of Mechanical and Aeronautical Engineering, Clarkson University, 8 Clarkson Avenue, Box 5725, Potsdam, NY 13699 e-mail:
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15
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Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev 2017; 1:136-145. [PMID: 28461940 PMCID: PMC5367617 DOI: 10.1302/2058-5241.1.000008] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Bone metastases of the long bones often lead to pain and pathological fractures. Local treatment consists of radiotherapy or surgery. Treatment strategies are strongly based on the risk of the fracture and expected survival. Diagnostic work-up consists of CT and biopsy for diagnosis of the primary tumour, bone scan or PET-CT for dissemination status, patient history and blood test for evaluation of general health, and biplanar radiograph or CT for evaluation of the involved bone. A bone lesion with an axial cortical involvement of >30 mm has a high risk of fracturing and should be stabilised surgically. Expected survival should be based on primary tumour type, performance score, and presence of visceral and cerebral metastases. Radiotherapy is the primary treatment for symptomatic lesions without risk of fracturing. The role of post-operative radiotherapy remains unclear. Main surgical treatment options consist of plate fixation, intramedullary nails and (endo) prosthesis. The choice of modality depends on the localisation, extent of involved bone, and expected survival. Adjuvant cement should be considered in large lesions for better stabilisation.
Cite this article: Willeumier JJ, van der Linden YM, van de Sande MAJ, Dijkstra PDS. Treatment of pathological fractures of the long bones. EFORT Open Rev 2016;1:136–145. DOI: 10.1302/2058-5241.1.000008.
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Affiliation(s)
- Julie J Willeumier
- Department of Orthopaedics, Leiden University Medical Centre, The Netherlands
| | | | | | - P D Sander Dijkstra
- Department of Orthopaedics, Leiden University Medical Centre, The Netherlands
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16
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Gausepohl T, Pennig D, Heck S, Gick S, Vegt PA, Block JE. Effective Management of Bone Fractures with the Illuminoss® Photodynamic Bone Stabilization System: Initial Clinical Experience from the European Union Registry. Orthop Rev (Pavia) 2017; 9:6988. [PMID: 28286623 PMCID: PMC5337777 DOI: 10.4081/or.2017.6988] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
The IlluminOss® system (IS) uses a light-curable polymer contained within an inflatable balloon catheter, forming a patient customized intramedullary implant. A registry was established in Germany and The Netherlands to prospectively collect technical and clinical outcomes in patients treated with IS for fractures of the phalange, metacarpal, radius, ulna, distal radius, fibula, clavicle and/or olecranon. Humeral, femoral, tibial and pelvic fractures were included under compassionate use. Procedural success included successful placement of the device at the target fracture site and achievement of fracture stabilization. Clinical and radiographic assessments were made postoperatively through 12 months. One hundred thirty two patients (149 fractures) were enrolled with most fractures (85%) resulting from low-energy trauma. Simple fractures predominated (47%) followed by complex (23%) and wedge (16%) fractures. Procedural success was achieved in all patients and no implants required removal or revision. Normal range of motion was realized in 87% of fractures. Radiographically, there was substantial cortical bridging, total dissolution of the fracture line, and complete fracture healing. Across a variety of fracture types, the IS provides a safe and effective approach for rapid healing and functional recovery.
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Affiliation(s)
| | | | | | - Sascha Gick
- St. Vinzenz Hospital GmbH , Cologne, Germany
| | - Paul A Vegt
- Department of Surgery, Albert Schweitzer Hospital , Dordrecht, The Netherlands
| | - Jon E Block
- Independent consultant , San Francisco, CA, USA
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17
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Hagenaars T, Van Oijen GW, Roerdink WH, Vegt PA, Vroemen JPAM, Verhofstad MHJ, Van Lieshout EMM. Functional recovery after treatment of extra-articular distal radius fractures in the elderly using the IlluminOss® System (IO-Wrist); a multicenter prospective observational study. BMC Musculoskelet Disord 2016; 17:235. [PMID: 27233355 PMCID: PMC4882870 DOI: 10.1186/s12891-016-1077-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/13/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Approximately 17 % of all fractures involve the distal radius. Two-thirds require reduction due to displacement. High redislocation rates and functional disability remain a significant problem after non-operative treatment, with up to 30 % of patients suffering long-term functional restrictions. Whether operative correction is superior to non-operative treatment with respect to functional outcome has not unequivocally been confirmed. The IlluminOss® System was introduced in 2009 as a novel, patient-specific, and minimally invasive intramedullary fracture fixation. This minimally invasive technique has a much lower risk of iatrogenic soft tissue complications. Because IlluminOss® allows for early mobilization, it may theoretically lead to earlier functional recovery and ADL independence than non-operative immobilization. The main aim of this study is to examine outcome in elderly patients who sustained a unilateral, displaced, extra-articular distal radius fracture that was treated with IlluminOss®. METHODS/DESIGN The design of the study will be a multicenter, prospective, observational study (case series). The study population comprises elderly (60 years or older; independent in activities of daily living) with a unilateral, displaced, extra-articular distal radius fracture (AO/OTA type 23-A2 and A3) that after successful closed reduction was fixed within 2 weeks after the injury with IlluminOss®. Critical elements of treatment will be registered, and outcome will be monitored until 1 year after surgery. The Disabilities of the Arm, Shoulder, and Hand score will serve as primary outcome measure. The Patient-Rated Wrist Evaluation score, level of pain, health-related quality of life (Short Form-36 and EuroQoL-5D), time to ADL independence, time to activities/work resumption, range of motion of the wrist, radiological outcome, and complications are secondary outcome measures. Health care consumption and lost productivity will be used for a cost analysis. The cost analysis will be performed from a societal perspective. Descriptive data will be reported. DISCUSSION The results of this study will provide evidence on the effectiveness of operative treatment of patients who sustained an extra-articular distal radius fracture with the IlluminOss® System, using clinical, patient-reported, and societal outcomes. TRIAL REGISTRATION The study is registered at the Netherlands Trial Register ( NTR5457 ; 29-sep-2015).
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Affiliation(s)
- Tjebbe Hagenaars
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands
| | - Guido W Van Oijen
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands
| | - W Herbert Roerdink
- Department of Surgery, Deventer Hospital, P.O. Box 5001, Deventer, GC, 7400, The Netherlands
| | - Paul A Vegt
- Department of Surgery, Albert Schweitzer Hospital, P.O. Box 444, Dordrecht, AK, 3300, The Netherlands
| | - Jos P A M Vroemen
- Department of Surgery, Amphia Hospital, P.O. Box 90158, Breda, RK, 4800, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, CA, 3000, The Netherlands.
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