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Score of Mirels for Predicting the Risk of Pathologic Fracture in a Bony Metastasis

Purpose: To evaluate a patient with metastatic cancer to a long bone using the score of Mirels.

Description

Mirels developed a score for predicting the risk of pathologic fracture in a metastasis to a long bone. This can help identify a patient who may benefit from more aggressive management. The author is from the University of Witwatersrand in Johannesburg, South Africa.


Patient selection:

(1) metastasis to a long bone

(2) no history of previous fracture

(3) no previous radiation to bone

(4) no prophylactic fixation of bone

 

Parameters:

(1) site

(2) pain

(3) radiographic appearance

(4) size as percent of shaft

 

Parameter

Finding

Points

site

upper limb (non weight bearing)

1

 

lower limb (weight bearing)

2

 

peritrochanteric

3

pain

none to mild

1

 

moderate

2

 

aggravated by function

3

radiographic appearance

blastic

1

 

mixed

2

 

lytic

3

percent of shaft involved

0 to 33%

1

 

34 to 67%

2

 

68 to 100%

3

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 4

• maximum score: 12

• The higher the score the greater the risk of pathologic fracture through the metastasis.

 

Total Score

Percent Fracture

4 to 6

0%

7

4%

8

15%

9

33%

10

72%

11

96%

12

100%

 


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Specialty

Objective

ICD-10