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    Patent Pending

    Mirels’ Criteria for Prophylactic Fixation

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

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

    When to Use
    Pearls/Pitfalls

    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
    +1
    Lower limb
    +2
    Trochanteric region
    +3
    Less than 1/3 of bone diameter
    +1
    1/3 to 2/3 of bone diameter
    +2
    More than 2/3 of bone diameter
    +3
    Blastic
    +1
    Mixed
    +2
    Lytic
    +3
    Mild
    +1
    Moderate
    +2
    Functional
    +3

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    In addition to Mirels’ Criteria, consider patient-specific factors such as comorbidities, predicted survival, other sites of disease, activity level, and bone mineral density when deciding whether or not to recommend prophylactic fixation.

    About the Creator
    Dr. Hilton Mirels
    Are you Dr. Hilton Mirels?