Carmine Zoccali1, Dario Attala2, Mattia Pugliese3, Alessandra Scotto di Uccio4, Jacopo Baldi2. 1. Oncological Orthopaedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. carminezoccali@libero.it. 2. Oncological Orthopaedics Department, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy. 3. Orthopedics and Traumatology School, Department of Surgery, Sapienza University of Rome, Piazzale Aldo Moro 3/5, 00100, Rome, Italy. 4. School of General Surgery, Hepatobiliary Surgery and Organ Transplant Unit, Department of Surgery, Sapienza University of Rome, Piazzale Aldo Moro 3/5, 00100, Rome, Italy.
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.
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.
Authors: M A Clara-Altamirano; D Y Garcia-Ortega; H Martinez-Said; C H S Caro-Sánchez; A Herrera-Gomez; M Cuellar-Hubbe Journal: Rev Esp Cir Ortop Traumatol (Engl Ed) Date: 2018-03-21
Authors: Amanda L McSweeney; Brett G Zani; Rose Baird; James R L Stanley; Alison Hayward; Peter M Markham; Gregory A Kopia; Elazer R Edelman; Robert Rabiner Journal: J Orthop Res Date: 2017-02-20 Impact factor: 3.494
Authors: Andrea Piccioli; Raimondo Piana; Michele Lisanti; Alberto Di Martino; Barbara Rossi; Francesco Camnasio; Marco Gatti; Pietro Maniscalco; Franco Gherlinzoni; Maria Silvia Spinelli; Davide Maria Donati; Roberto Biagini; Rodolfo Capanna; Vincenzo Denaro Journal: Injury Date: 2017-10 Impact factor: 2.586
Authors: Guido W Van Oijen; Peter D Croughs; Tjebbe Hagenaars; Michael H J Verhofstad; Esther M M Van Lieshout Journal: J Bone Jt Infect Date: 2019-09-18