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

• Published in: Operative techniques in orthopaedics Vol. 30; no. 2; p. 100805
• Main Authors: Fourman, Mitchell S., Rothenberg, Adam C., McGough, Richard L., Weiss, Kurt R., Goodman, Mark A.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.06.2020
• ISSN: 1048-6666; 1558-3848
• DOI: 10.1016/j.oto.2020.100805

A photodynamic implant is a useful modality for stabilizing intrinsically weak or osteoporotic bone defects or fractures in select patients. Advantages of these implants are their minimally invasive nature, quick annealing, and flexible accommodation of bowed medullary canals. We have determined experientially that these implants can be used successfully in the long bones of the lower extremity, even in patients with pathologic bone stock. However, creation of the appropriate biomechanical conditions for fracture healing is critical to technical success. This is evidenced in our experience managing a 30-year-old active male with osteogenesis imperfecta, who presented with chronic pain and disability after failing conventional intramedullary nailing of his left femur. He presented with distal implant cut-out and a mid-shaft stress fracture nonunion. He underwent implant removal and intramedullary stabilization using 3 photodynamic intramedullary implants. The patient healed uneventfully, returned to full weightbearing and work 1 month after surgery, and was asymptomatic 18 months postoperatively. At this time he complained of similar pain on his right side, and implant cutout and a nonunion at the apex of a large varus deformity of the subtrochanteric area of his hip was noted. A similar 3-implant photodynamic nailing was performed, but the patient began to complain of groin pain 1 month after surgery, and 2 months postoperatively was unable to weightbear. It was found that he had fractured through the nonunion. Plate fixation with deformity correction was performed, after which the patient healed uneventfully and is now being advanced to full weight bearing.