High rate of fracture in long-bone metastasis: Proposal for an improved Mirels predictive score

Crenn, Vincent; Carlier, C; Sailhan, Frédéric; Bonnevialle, P.

doi:10.1016/j.otsr.2020.03.034

Cited by 17 publications

(12 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The type of surgery is comparable to the literature, with intramedullary nailing being the procedure of choice in most cases as it is reliable for both impending and fractured proximal humerii. 3 The overall fracture rate of 76% was high, which is in keeping with a lower rate of surgery (therefore, a lower rate of prophylactic fixation) compared to lower limb lesions, 6,10 although this has been incompletely quantified previously. In addition, the majority of lesions which went on to fracture did so within 3 months (16/20, 80%), emphasizing the importance of the orthopedic referral as a "crisis point" in the clinical progression of a known upper limb metastasis.…”

Section: Patient Cohort and Demographicsmentioning

confidence: 70%

Mirels’ score for upper limb metastatic lesions: do we need a different cutoff for recommending prophylactic fixation?

Hoban¹,

Downie²,

Adamson³

et al. 2022

JSES International

View full text Add to dashboard Cite

Section: Patient Cohort and Demographicsmentioning

confidence: 70%

Mirels’ score for upper limb metastatic lesions: do we need a different cutoff for recommending prophylactic fixation?

Hoban¹,

Downie²,

Adamson³

et al. 2022

JSES International

View full text Add to dashboard Cite

“…Pain is a subjective assessment and can have multiple causes (presence of tumor, weakened bone, other metastatic lesions, bursitis, arthritis) that may or may not be relevant to the clinical question of fracture risk. Crenn et al 21 reported a higher VAS pain score in patients with a completed pathologic fracture rather than impending fracture, while Dijkstra et al 22 found that only increasing pain, rather than presence of pain, was associated with fracture. We found that neither calculated femur strength nor LSR correlated with preoperative VAS pain and demonstrated only a weak correlation with Mirels’ score.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, to further corroborate existing literature, we hypothesized that (3) weak relationships would be observed between FE-based mechanical assessments of fracture risk and the patient’s visual analog scale (VAS) pain score, Mirels’ score, and the decision to operate. While multiple clinical risk factors have been associated with pathologic fractures in MBD, 21,22 we focused only on clinical factors directly related to Mirels’ criteria.…”

Section: Introductionmentioning

confidence: 99%

Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease

Johnson

Goetz

Brouillette

et al. 2022

Proc Inst Mech Eng H

View full text Add to dashboard Cite

Metastatic bone disease (MBD) is often managed by non-specialized orthopedic surgeons who rely on Mirels’ criteria to predict pathologic fracture risk. However, low specificity of Mirels’ criteria implies many lesions are scored at high fracture risk when the actual mechanical fracture risk is minimal. Our goal was to retrospectively compare mechanical fracture risk in MBD patients to Mirels’ score and clinical treatment received. Using a CT-based finite element (FE) model of the proximal femur affected by MBD, femur strength and load-to-strength ratio (LSR) were determined for 52 femurs from 48 patients. Associations of femur strength with pain and Mirels’ scores (Pearson r/Spearman ρ correlations), and the decision to operate (percentile analysis), and associations of LSR with pain and Mirels’ scores (Spearman correlations) were determined. Nineteen of 52 femurs (37%) had a very low computed mechanical fracture risk (LSR < 0.4); 5 of those 19 underwent prophylactic stabilization, suggesting that clinical decision-making in MBD is substantially influenced by non-mechanical factors that likely overestimate pathologic fracture risk. Of the 30 femurs managed non-operatively, 24 had a low computed mechanical fracture risk (LSR ≤ 0.5), none of which (0%) experienced a fracture within 9 months. Patient-reported pain did not correlate with femur strength ( r = −0.05, p = 0.748) nor with LSR (ρ = 0.07, p = 0.632). Mirels’ score correlated weakly with femur strength (ρ = −0.32, p = 0.019) and with LSR (ρ = 0.29, p = 0.034). Computational mechanical tools like this FE model could be used as a clinical decision aid when considering non-surgical management in appropriate patients, potentially alleviating nonessential surgical treatment in some patients with femur MBD.

show abstract

“…The size of the cortical defect is certainly the main parameter for long bones. However, the Mirels' score lacks sensitivity and specificity [54][55][56][57][58], especially in intermediate situations [54]. Thus, there is a need to obtain an accurate evaluation of the strength of the tumoral bone segment, which will provide physicians with a more accurate tool to optimize locomotor strategy and oncology programs, to prevent bone fractures, and improve the survival and quality of life of these patients.…”

Section: Bone Metastatic Fracture Risk Scores and Their Limitmentioning

confidence: 99%

Fracture Risk Evaluation of Bone Metastases: A Burning Issue

Confavreux

Follet

Mitton

et al. 2021

Cancers

View full text Add to dashboard Cite

Major progress has been achieved to treat cancer patients and survival has improved considerably, even for stage-IV bone metastatic patients. Locomotive health has become a crucial issue for patient autonomy and quality of life. The centerpiece of the reflection lies in the fracture risk evaluation of bone metastasis to guide physician decision regarding physical activity, antiresorptive agent prescription, and local intervention by radiotherapy, surgery, and interventional radiology. A key mandatory step, since bone metastases may be asymptomatic and disseminated throughout the skeleton, is to identify the bone metastasis location by cartography, especially within weight-bearing bones. For every location, the fracture risk evaluation relies on qualitative approaches using imagery and scores such as Mirels and spinal instability neoplastic score (SINS). This approach, however, has important limitations and there is a need to develop new tools for bone metastatic and myeloma fracture risk evaluation. Personalized numerical simulation qCT-based imaging constitutes one of these emerging tools to assess bone tumoral strength and estimate the femoral and vertebral fracture risk. The next generation of numerical simulation and artificial intelligence will take into account multiple loadings to integrate movement and obtain conditions even closer to real-life, in order to guide patient rehabilitation and activity within a personalized-medicine approach.

show abstract

High rate of fracture in long-bone metastasis: Proposal for an improved Mirels predictive score

Cited by 17 publications

References 45 publications

Mirels’ score for upper limb metastatic lesions: do we need a different cutoff for recommending prophylactic fixation?

Mirels’ score for upper limb metastatic lesions: do we need a different cutoff for recommending prophylactic fixation?

Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease

Fracture Risk Evaluation of Bone Metastases: A Burning Issue

Contact Info

Product

Resources

About