Photodynamic bone stabilization: a novel approach to elderly metastatic patients

Treatment of metastatic bone fractures could be challenging, especially in elderly oncologic patients. Recent treatment options like photodynamic nailing are a mini-invasive procedure that allows fractures stabilization and early recovery. We reviewed five studies following the PRISMA guidelines obtaining 148 patients treated with Photodynamic Bone Stabilization (PBS). Mean follow-up period after surgery was 10.5 months as reported in 4 of 5 studies (range 1.5-24 months). All patients evaluated have been treated due to metastasis from other primary tumors. IlluminOss® System demonstrated positive outcomes in the reviewed studies, decreasing mean VAS score from pre-surgery values (7.71) to post-surgery values (4.19). As reported in 3 of 5 studies evaluated, mean preoperatively MSTS score was 30.38% (27-40%), earliest postoperative MSTS was 61.59% (52-87.8%). Complications were reported in 27 patients (18.24%). Several complications were described: device rupture, thromboembolic events, aseptic dehiscence, and malunion, respectively, in 14 patients (9.45%), 3 patients (2.02%), 2 patients (1.35%), 2 patients (1.35%). Our analysis offers a preliminary overview of the outcomes and complications related to PDNs (IlluminOss® System). While classical intramedullary nailing is often linked to favorable functional outcomes, the risk of complications, such as: hardware failure, and the necessity for future hardware removal, should not be ignored. The results obtained from this analysis are promising; however, further randomized studies will be necessary to determine the superiority of the method over current treatments.