Mirels scoring system to predict impending pathologic fracture

Score	Size	Site	Radiographic nature	Degree of pain
1	1/3 of cortex	Upper extremity	Osteoblastic lesions	Mild
2	1/3 to 2/3 of cortex	Lower extremity	Mixed osteolytic and osteoblastic lesions	Moderate
3	More than 2/3 of cortex	Peritrochanteric region	Purely osteolytic lesions	Limits function
Points	Fracture risk		Recommendation
≤7	<10%		Observe
8	15%		Consider fixation
≥9	33% for 9 points, >50% for 10 points or more		Prophylactic fixation

Mirels scoring system reproduced with permission from: Johnson SK, Knobf MT. Surgical interventions for cancer patients with impending or actual pathologic fractures. Orthop Nurs 2008; 27:160. DOI: 10.1097/01.NOR.0000320543.90115.d5. Copyright © 2008 National Association of Orthopaedic Nurses. Unauthorized reproduction of this material is prohibited.

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Mirels scoring system to predict impending pathologic fracture