Which parameters are combined in the Mirels scoring system used to decide whether an impending pathological long-bone fracture should be surgically stabilised?

• A Lesion location relative to joint, cortical thickness, patient weight, and gait
• B Age, tumour histology, serum calcium, and albumin
• C Site, size of lesion, nature of lesion, and pain ✓
• D Site, number of lesions, radioisotope uptake, and ESR

Explanation

Mirels scores four variables, each rated 1 to 3: upper limb versus lower limb site, lesion size less than one third versus greater than two thirds of diameter, lytic versus blastic nature, and mild versus severe functional pain. C total score of 9 or more predicts fracture risk high enough to justify prophylactic fixation before radiotherapy or chemotherapy. Histology and laboratory markers are not part of this score.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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Written and medically reviewed by the StethoPrep medical team.