Metastatic bone disease is the most common malignancy affecting the skeleton, far exceeding primary bone tumours. In this comprehensive orthopaedic masterclass, we cover everything from the classic BPLTK primary tumours and radiographic patterns to critical surgical decision-making using the Mirels score. ⏱ Chapters 0:00 Intro 0:25 Essentials 1:13 Classification 1:54 Bpltk 2:24 Radiographic 3:05 Mirels 3:39 Mirels Algorithm 4:21 Management 5:22 Embolization 5:53 Cord Compression 6:48 Clinical reasoning — Proximal-Femur 7:36 Clinical reasoning — Unknown-Primary This video provides an in-depth, clinically focused review of metastatic bone disease for orthopaedic learners. We explore the underlying pathophysiology, including Batson's venous plexus and the vicious cycle of osteoclast and osteoblast activation. You will learn how to identify lytic, blasticand mixed lesions, interpret the Mirels scoring system for impending pathological fracturesand understand the critical pre-operative requirement of embolisation for highly vascular kidney and thyroid metastases. The overarching goal of management is palliationand we detail how to achieve durable fixation that allows immediate weight-bearing for patients. 🦴 IN THIS VIDEO YOU'LL LEARN • Identify the five most common primary tumours that metastasise to bone using the BPLTK mnemonic • Differentiate between lytic, blasticand mixed radiographic appearances and their underlying cellular biology • Calculate and interpret the Mirels scoring system to assess impending pathological fracture risk • Understand the indications and thresholds for prophylactic orthopaedic fixation • Recognise the critical importance of pre-operative embolisation for renal and thyroid bone metastases • Explain the anatomical and physiological mechanisms of bone spread, including Batson's valveless venous plexus • Identify the clinical red flags and emergency management of metastatic spinal cord compression • Appreciate the palliative surgical goals of metastatic bone disease management ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ Metastatic bone disease is 25-30 times more common than primary bone tumours. ✔️ Kidney and thyroid metastases are highly vascular and require embolisation 24-48 hours before surgery. ✔️ Prostate classically causes blastic lesions, while kidney, thyroidand lung cause lytic destruction. ✔️ A Mirels score of 9 or higher indicates a high fracture risk and warrants prophylactic fixation. ✔️ Orthopaedic constructs for metastatic disease must be durable and allow immediate weight-bearing. 👩⚕️ WHO THIS IS FOR This masterclass is highly relevant for orthopaedic trainees, junior doctorsand medical students seeking a comprehensive understanding of skeletal metastases. Interested patients and caregivers looking to understand the orthopaedic management of secondary bone tumours will also find this educational. 📚 RELATED TOPICS: Mirels Scoring System for Pathological Fractures · Primary Bone Tumours vs Secondary Bone Metastases · Orthopaedic Management of Spinal Cord Compression · Batson's Venous Plexus and Tumour Spread · Pre-operative Embolisation in Orthopaedic Oncology · The Vicious Cycle of Bone Destruction 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #metastaticbonedisease #orthopedicsurgery #mirelsscore #bonetumour #pathologicalfracture #orthopaedicsurgery #medicaleducation #orthooncology #skeletalmetastases #bonemetastasis #orthopaedicteaching