Standalone Photodynamic Intramedullary Implants in the Treatment of Bilateral Refractory Femoral Nonunions in a Patient with Osteogenesis Imperfecta: Significant Utility in Load-Bearing Bones, But Not a Replacement for Biomechanical Optimization

How I do it: Percutaneous stabilization of symptomatic sacral and periacetabular metastatic lesions with photodynamic nails

“…In select cases with particularly large lesions two implants were used for augmented space filling in a manner previously shown to be effective in the distal femoral metaphysis (Figure 3C), 11,12 reaming up to 8 mm and using a 9 mm implant. We have also augmented our constructs with a second S1 implant or a supplemental PDN across the S2 corridor, which can be performed in the same manner 11 and still permits reaming up to 8 mm for a 9 mm implant (Figure 3C). Photodynamic nail inflation with liquid polymer was performed under fluoroscopic guidance to ensure that the S1 foramina were not encroached upon and the lesion was fully filled.…”

“…The authors report cortical bridging and elimination of the fracture line on X-ray in all cases, with maintenance of reduction in 84% of cases. While a particular advantage of PDN is that can serve as an augmentation medium for metal implant fixation through pathologic bone,21 either as a part of initial treatment or as a result of a complication thereof, the efficacy of PDN as a standalone implant in the stabilization of bilateral femoral nonunions in a young, active patient with osteogenesis imperfecta has been shown by members of our group 11.…”

Photodynamic bone stabilization for traumatic and pathologic fractures: a systematic review of utilization, complications, and patient-reported outcomes

“…One Level III [ 9 ], Eight Level IV [ 1 , 2 , 5 – 7 , 12 – 14 ], and three Level V [ 8 , 15 , 16 ] studies reported complications following PBSS. A total of sixty complications were reported (Table 3 ).…”

Augmenting Pathologic Acetabular Bone Loss With Photodynamic Nails to Support Primary Total Hip Arthroplasty

“…PDNs have been previously utilized in multiple weight-bearing applications, including as femoral stabilization of pathologic bone [ 9 ] and as subchondral support for the native acetabulum in patients with a metastatic disease [ 8 ]. PDNs are longitudinally strong and rotationally stable implants that do not require screw stabilization [ 21 ].…”

“…We have previously published a technique that uses photodynamic nails (PDNs) to augment the pelvic and sacral bone stock of patients with symptomatic metastatic disease [ 8 ]. PDNs demonstrate impressive resistance to compressive forces [ 9 ] and can be delivered via a flexible catheter, permitting anatomic reconstruction of the acetabular columns. PDNs are also radiolucent, which permits effective monitoring for disease progression without a metal artifact.…”