General Health · Hip

Metastatic bone disease

A long bone metastasis is scored for fracture risk across four variables — site, pain, radiographic appearance and lesion size — to decide between prophylactic fixation and radiotherapy.

What you are actually deciding

A score of 9 or more conventionally indicates prophylactic fixation, but the score over-predicts fracture, so applying it mechanically leads to unnecessary surgery. Life expectancy and tumour response matter alongside it, and spinal metastases need a spine-specific score instead.

Clinical calculator1

Mirels Calculator4 items
Mirels' Score for Pathological Fracture RiskMirels' score estimates the risk of pathological fracture through a long bone metastasis by scoring four variables — site, pain, radiographic appearance and lesion size — from 1 to 3 each, giving a total from 4 to 12, where 9 or more is the conventional threshold for prophylactic fixation.

Classification system1

ECOG Classification1 items
ECOG Performance StatusThe ECOG Performance Status grades a patient’s functional capacity from 0, fully active, to 4, completely disabled and confined to bed or chair, with 5 denoting death — and in orthopaedic oncology it is the single figure that most often decides whether a metastatic lesion is worth fixing.

Clinical calculator1

Classification system1

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