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    Mirels’ Criteria for Prophylactic Fixation

    Predicts risk of pathologic fracture in patients with long bone metastasis.


    Use in patients with known long bone metastasis. Do not use if history of fracture or previous irradiation.

    When to Use

    Patients with known long bone metastasis, without history of fracture or previous irradiation.

    • Shown to have greater variability in agreement when scored by medical and radiation oncologists, to whom these patients are most likely to present.
    • Can only be used to predict fracture risk in long bones (i.e., not in vertebral mets).
    • Better validated than the earlier Harrington Criteria.
    • While the original paper describes the size of the lesion as a percentage of the cortex, in practice it is classified as a percentage of the width (diameter) of the bone at that level.
    • Predicts fracture risk in the 6 months after radiotherapy, which may not be relevant for many patients (i.e., if no plans for radiotherapy and/or short life expectancy).
    Upper limb
    Lower limb
    Trochanteric region
    Less than 1/3 of bone diameter
    1/3 to 2/3 of bone diameter
    More than 2/3 of bone diameter


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    Creator Insights
    Dr. Hilton Mirels

    About the Creator

    Hilton Mirels, MD, is an orthopaedic surgeon and has been in practice for almost 40 years. He completed his training at the University of the Witwatersrand in Johannesburg, South Africa. Dr. Mirels is best known for his eponymous criteria for long bone fracture.

    To view Dr. Hilton Mirels's publications, visit PubMed

    Are you Dr. Hilton Mirels? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Hilton Mirels
    Are you Dr. Hilton Mirels?