A 58-year-old woman with metastatic lung carcinoma has a purely lytic lesion in the intertrochanteric region of the left femur. She has pain on weight bearing that limits walking. The lesion occupies more than two-thirds of the diameter of the bone. According to the Mirels scoring system, her total score is 10. The most appropriate next step is:

• A Prophylactic intramedullary nailing before radiotherapy ✓
• B Analgesia and radiotherapy alone
• C Observation with monthly radiographs
• D Bisphosphonate therapy alone

Explanation

Mirels scoring assigns points for site, pain, radiographic character and lesion size; a score of 9 or more predicts imminent pathological fracture and mandates prophylactic stabilisation. This patient scores 2 for lower limb site, 2 for functional pain, 3 for a purely lytic lesion and 3 for size greater than two-thirds, totalling 10. Prophylactic intramedullary nailing followed by postoperative radiotherapy prevents the far worse morbidity of fracture through tumour.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.