Mirels_Fracture_Risk_Score v.1

Mirels Scoring system predicts the risk for pathologic fracture in patients with long bone metastasis at 6 months post-irradiation.

Rashmi Damodaran

models@cambiocds.com

@CambioCDS

To calculate the Mirels Score and thereby predict the fracture risk at 6 months post-irradiation and provide recommendations accordingly.

Used to determine the need for prophylactic fixation by predicting the risk for impending fracture based on the Mirels score. Formula: Mirels Score is calculated by the addition of the selected points of all the 4 variables. Score 1 2 3 Site of lesion Upper limb Lower limb Trochanteric region Size of lesion <1/3 of bone diameter 1/3-2/3 of bone diameter >2/3 of bone diameter Nature of lesion Blastic Mixed Lytic Pain Mild Moderate Functional Interpretation of the Score: Mirels Score Fracture Risk at 6 months post-irradiation Recommendation <= 7 0 – 4% Safe to irradiate with Minimal risk of fracture 8 15% Consider prophylactic fixation >= 9 > 33% Prophylactic fixation indicated

Must be used to predict the risk for fracture in long bone metastasis and not in vertebral metastasis Must not be used in patients with a history of fracture or previous irradiation

1. Mirels H. The Classic: Metastatic Disease in Long Bones A Proposed Scoring System for Diagnosing Impending Pathologic Fractures. Clinical Orthopaedics and Related Research [Internet]. 2003 Oct [cited 2020 May 12];415. Available from: insights.ovid.com 2. Damron T, Morgan H, Prakash D, Grant W, Aronowitz J, Heiner J. Critical Evaluation of Mirels’ Rating System for Impending Pathologic Fractures. Clinical Orthopaedics and Related Research [Internet]. 2003 Oct [cited 2020 May 12];415. Available from: insights.ovid.com 3. Jawad MU, Scully SP. In Brief: Classifications in Brief: Mirels’ Classification: Metastatic Disease in Long Bones and Impending Pathologic Fracture. Clin Orthop Relat Res. 2010 Oct;468(10):2825–7.

OBSERVATION.mirels_criteria_for_prophylactic_fixation.v0, EVALUATION.mirels_criteria_for_prophylactic_fixation_assessment.v0