Metastatic disease to long bones

Mirels developed a system in 1989 to predict fracture of long bones based on:

• the location of the lesion (upper limb, lower limb, peritrochanter)
• the degree of pain caused by the lesion (mild, moderate, severe)
• the type of lesion (lytic, blastic, mixed)
• the degree of cortex taken up by the lesion (<1/3, 1/3-2/3, >1/3)

Mirels score is:    Reset

Total score of 12

<= 7 low risk of fracture

8 is associated with a 15% risk for fracture

>= 9 risk is 33% of fracture ( Mirels concluded that a score of 9 or greater is an indication for prophylactic fixation)