![]() ![]() ![]() The purpose of this study was to evaluate if the proportion of body weight that can be put through the affected leg can predict pathological fractures in patients with metastatic disease of the lower limb and to compare this to the Mirels score.Ī prospective study approved by the Health Research Authority (HRA: 233366) was conducted on all adult patients with metastatic disease of the lower limb presenting to a specialist bone tumour unit between September 2013 and September 2017. Although the Mirels score is commonly used in clinical practice, it has several limitations as most of the components of the score are subjective and prone to variation 8. A Mirels score of nine estimates a 33% risk of pathological fracture and surgical intervention is recommended 7. Each component can be scored from one to three and consequently the Mirels score ranges from four to 12. The score has four components: anatomical site, size, radiographic appearance of the lesion and severity of pain. Mirels developed a scoring system to predict impending fractures. This ensures that prophylactic fixation is only performed when necessary, and when the benefits of fixation outweigh the risks of major surgery. Prophylactic fixation is also reported to prevent the complications of pathological fractures, namely delayed or non-union and the need for re-operation 6.Ĭonsequently, it is of importance that clinicians can accurately predict impending pathological fractures or be reassured when fracture is unlikely. The literature reports that patients undergoing prophylactic fixation of metastatic lesions lose less blood in theatre, have a shorter inpatient stay and superior functioning after surgery than patients who undergo fixation of a pathological fracture 5. ![]() The mainstay of clinical management for metastatic bone disease is palliative and aims to improve quality of life, avoiding pathological fracture 3, 4. Pathological fractures require urgent clinical evaluation and usually surgery is performed in less than ideal conditions 1. Pathological fractures which arise as a consequence of metastatic disease compromise patient morbidity and mortality 1, 2. If less than 85% of total body weight can be put through the affected limb, the risk of fracture increases, and consideration of treatment is suggested. The use of single stance body weight can be a useful in conjunction with the Mirels score to predict pathological fracture. No patient below the threshold level of 85% single stance body weight sustained a pathological fracture. ![]() The optimum threshold to predict pathological fracture was 85% of total body weight. Patients who underwent surgery could weight bear significantly less than those who did not have surgical intervention. Receiver Operator Characteristic curves were used to identify the optimum threshold level of single stance weight bearing to predict fracture and compared to the Mirels score. A prospective observational study was conducted in patients with metastatic disease in the lower limb. The aim of this study was to investigate if the risk of pathological fracture can be predicted with the proportion of body weight that can be put through the affected leg in patients with metastatic bone disease of the lower limb. ![]()
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