Evidence brief
Metastatic Bone Disease: Mirels Scoring for Pathological Fracture Risk
Scoring: site, pain, lesion type, size (1-3 each)
Score ≤7: low fracture risk, radiotherapy
Score ≥9: high fracture risk, prophylactic fixation
Score 8: borderline, clinical judgment
Helps prioritize surgical intervention
Mirels score provides objective assessment of pathological fracture risk, guiding prophylactic fixation decisions in metastatic bone disease.
Know Mirels criteria: Site (upper/lower/peritrochanteric), Pain (mild/moderate/functional), Lesion (blastic/mixed/lytic), Size (<1/3, 1/3-2/3, >2/3). Score ≥9 = prophylactic fixation. Discuss limitations and clinical judgment. Most common sites: proximal femur, humerus.
Mirels H. Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;(249):256-264.
Level IV
Case series or case reports