Device-related clinical outcomes of the Photodynamic Bone Stabilization System in the treatment of pathologic humerus fractures: A Meta-Analysis of The Literature

Objectives: The humerus is one of the most common sites of metastatic disease to bone. Over the past decade, however, a novel, non-metallic Photodynamic Bone Stabilization System (PBSS) has become available, creating growing interest in the use of the system to treat pathologic fractures. We aimed to analyze device-related clinical outcomes extracted from a meta-analysis of the literature to determine appropriate use cases in the treatment of pathologic humerus lesions.

Methods: Using predetermined inclusion and exclusion criteria, Pubmed, Medline and Embase electronic databases were searched in January 2023 for relevant articles relating to IlluminOss implants for humerus pathologic fracture. Keywords used were “IlluminOss” OR “Photodynamic Bone Stabilization System” AND “Fracture”.

Results: 114 articles were identified and screened. A total of 67 humerus lesions stabilized with IlluminOss from 5 studies were included for review. 36 (54%) of these patients were female. There were 51 complete pathological fractures and 16 impending fractures. Sixteen of 67 (24%) patients had implant-related complications, including broken implants (13), traumatic periprosthetic fracture (1), proximal migration of implant (1), and intra-articular penetration by a supplemental screw (1). All complications occurred in the setting of complete pathological fractures (P value = 0.01). The distal humerus was the most common location (60%) for complications (P value = 0.02). Complications trended to occur more frequently in females (75%) and patients with renal cell carcinoma (33%), however, these factors were not statistically significant.

Conclusions: The IlluminOss implant has been successfully used to treat many pathological humerus fractures, however, the rate of implant-related complications was high in complete pathologic fractures located in the distal humerus. The most common mode of failure was broken implant. Orthopedic surgeons should consider complete pathologic fractures in the distal humerus as high risk for implant failure and may need to augment their stabilization or choose alternative means of treatment.