Management of Impending and/or Pathologic Fractures of the Proximal Radius in the Setting of Metastatic Bone Disease With an Intramedullary Photodynamic Nail

Metastatic bone disease of the radius is rare, but the functional loss of an upper extremity can profoundly impact patient quality of life and hinder independent living. When the mechanical stability of the radius is compromised, surgical intervention such as intramedullary (IM) nailing or plating may be considered in combination with radiation therapy (RT) to alleviate pain, control local tumor progression, and provide immediate stability to the bone. There are several limitations to traditional metallic IM nails, such as limited use in adults, complicated postoperative CT planning for RT, the obscuring of local tumor recurrence or progression, and metal scattering that affects RT dosing. Photodynamic nail IM stabilization is a novel, minimally invasive surgical technique that circumvents several of these shortcomings, in which a photocurable monomer is introduced through a balloon that can conform to the irregularities of an osteolytic metastatic lesion. We describe the photodynamic nail technique for the treatment of impending and/or pathologic fractures of the proximal radius.