medical decision support medical decision support
Sign In

Score of Van der Linden et al for Predicting Pathologic Fracture of the Femur (Modified Mirels Score)

Purpose: To evaluate a patient with metastatic cancer in the femur for risk of pathologic fracture using the score of Van der Linden et al (modified Mirels score).

Description

Van der Linden et al used a modification of Mirels score for predicting the risk of pathologic fracture in a femur with metastatic cancer. This can help identify a patient who may benefit from more aggressive management. The authors are from Leiden University in The Netherlands.


Patient selection: metastasis to the femur

 

Parameters:

(1) anatomic location within the femur

(2) degree of pain using a Likert scale from 0 (no) to 10 (worst imaginable)

(3) radiographic appearance

(4) percent of cortical circumference involved

 

Parameter

Finding

Points

anatomic location

distal femur

2

 

shaft

2

 

proximal femur

3

pain

0 or 1

0

 

2, 3 or 4

1

 

5, 6 or 7

2

 

8. 9 or 10

3

radioagraphic appearance

blastic

1

 

lytic

3

 

mixed

2

percent of cortical circumference involved

< 33%

1

 

33 - 67%

2

 

> 67%

3

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 4 (in the footnote to Table II the minimum score is given as 5, but this assumes that the minimum pain score is 1)

• maximum score: 12

• A score < 9 was not associated with pathologic fracture.

• A score >= 9 may or may not be associated with fracture.

 

Performance:

• The score is 100% sensitive but only has a specificity of 13%. This can result in an overestimate of the risk for fracture.

 

Risk factors better predictive of pathologic fracture:

(1) axial cortical involvement > 30 mm

(2) circumferential cortical involvement > 50%


To read more or access our algorithms and calculators, please log in or register.

Specialty

Objective

ICD-10