Mirels criteria for long-bone Pathological fracture risk.
Bone Integrity Scan
Assess the risk of pathological fracture based on site, pain, lesion morphology, and size to determine the necessity of surgical stabilization.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating patients presenting with osseous metastases in long bones (femur, humerus).
Used frequently by spine and neurosurgeons consulting on polytrauma or disseminated metastatic disease to prioritize which lesions risk catastrophic failure.
Section 2
Literature
Development
Developed by Dr. Hilton Mirels in 1989. While most scoring systems evaluated spinal instability (like SINS), Mirels recognized the dire morbidity associated with letting a long bone metastasis fracture spontaneously compared to elective intramedullary nailing prior to starting radiation.
Section 3
Pearls/Pitfalls
Spine vs Appendicular Skeleton
Do not use the Mirels score for spinal metastases. For the spine, the Spinal Instability Neoplastic Score (SINS) is the correct validated tool. Mirels is exclusively for the appendicular skeleton, with heavy penalization for weight-bearing joints (peri-trochanteric).
Section 4
Evidence Appraisal
Primary Reference
Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures
Mirels H • Clin Orthop Relat Res. 1989;(249):256-64
