Safety and Efficacy Study of Treatment of Pathological Fractures in Humerus

This is a prospective, multi-center, open label study to evaluate the Photodynamic Bone
Stabilization System (PBSS) when used for the treatment of painful impending and actual
fractures of the humerus secondary to metastatic malignancy.

Inclusion Criteria:

- General Inclusion Criteria

1. Skeletally mature adult males and females 18 years of age or older.

2. Impending or actual pathological fracture of the humerus, secondary to metastatic bone
disease.

3. Females: neither pregnant nor intending to become pregnant during the course of the
study, defined as:

1. Postmenopausal for at least 1 year OR

2. Documented oophorectomy or hysterectomy

3. Surgically sterile OR

4. If of childbearing potential, must be practicing double-barrier method of birth
control, be willing to avoid pregnancy for the period of study participation and
have a negative pregnancy test at screening

4. Patient, or his/her legally authorized representative, is able to understand and
provide informed consent.

5. Willing and able to comply with post-operative treatment protocol and follow-up visit
schedule.

6. VAS Pain Score > 60mm on 100mm scale.

-Impending Fracture-Specific Inclusion Criteria

7. Documented presence of at least one metastatic lesion of the humerus.

8. Mirels Criteria Score ≥ 8. (specific to the target humeral lesion and subject to
minimum VAS score requirements)

9. Destruction of cortical bone at impending fracture site > 50%.

-Actual Fracture-Specific Inclusion Criteria

10. Fracture is closed, Gustilo Type I or II.

Exclusion Criteria:

- General Exclusion Criteria

1. Primary tumor (osteogenic origin, etc.) at site.

2. Impending or actual fracture at any other location that, in the Investigator's
opinion, would preclude ability to assess pain and/or function in the target humerus.

3. Active or incompletely treated infections that could involve the device implant site.

4. Distant foci of infection that may spread to the implant site.

5. Allergy to implant materials or dental glue.

6. In the investigator's judgment, functional deficit in the target humerus with an
etiology other than bone metastases (e.g. due to vascular insufficiency).

7. In the investigator's judgment, focal neurologic deficit as a result of metastases in
the brain, spine, or other central nervous system disorders.

8. Uncooperative patients, or patients who are incapable of following directions (for
example, as a consequence of a neurological or psychiatric disorder).

9. Prisoner

-Impending Fracture-Specific Exclusion Criteria

10. Mirels Score < 8 (specific to target humeral lesion).

11. Destruction of cortical bone at impending fracture site < 50%.

12. Prior surgery and/or prior fracture of affected site.

13. Any articular component to impending fracture site.

-Actual Fracture-Specific Exclusion Criteria

14. Open fractures with severe contamination.

15. Extremely comminuted fractures where insufficient holding power of the balloon on the
intramedullary canal is probable.

16. Patients whose intramedullary canal at site of fracture measures smaller than the
diameter of the sheath provided.