# Mirels — Mirels scoring for impending pathologic fracture

> Scores risk of pathologic fracture in long bone metastases.

**Situação:** vigente · **Órgão:** Musculoesquelético · **Órgão emissor:** Orthopedic consensus · **Versão:** 1989 · **Ano:** 1989

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: XR
- Fonte primária: Mirels H. Metastatic disease in long bones: a proposed scoring system (Mirels) (1989) — https://doi.org/10.1097/00003086-198912000-00027
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| <=7 | Low risk | Total Mirels score of 7 or less. The score sums four variables each rated 1-3: site (1 upper limb, 2 lower limb, 3 peritrochanteric), pain (1 mild, 2 moderate, 3 functional/mechanical), lesion nature (1 blastic, 2 mixed, 3 lytic), and lesion size as fraction of cortex (1 under 1/3, 2 between 1/3 and 2/3, 3 over 2/3). | Low fracture risk; managed conservatively with analgesia and radiotherapy plus observation. Prophylactic internal fixation is generally not indicated. | Low probability of pathologic fracture; a score of 7 corresponds to about a 4% fracture risk, so lesions in this band are considered safe to irradiate without prophylactic fixation. | Criteria/management: PMC3049613, Mirels' Staging System, Table 1 (variables) and Table 2 (<=7 = irradiate/observe). Risk figure (score 7 ~4%): PMC3049613 Table 2, corroborated by PMC11941509. | ✓ |
| 8 | Borderline | Total Mirels score of exactly 8 (intermediate band), summed from the four variables (site, pain, lesion nature, lesion size), each scored 1-3. | Borderline / clinical dilemma: decision between prophylactic fixation and conservative treatment rests on clinical judgment, since only a minority of these lesions fracture. | Approximately 15% probability of pathologic fracture - intermediate risk that does not clearly favor either fixation or conservative care. | Criteria/management: PMC3049613, Mirels' Staging System, Table 2 (8 = clinical judgment). Risk figure (~15%): PMC3049613 Table 2, corroborated by PMC11941509. | ✓ |
| >=9 | High risk, prophylactic fixation advised | Total Mirels score of 9 or greater (high band), summed from the four variables (site, pain, lesion nature, lesion size), each scored 1-3. | Prophylactic internal fixation is indicated, ideally performed before irradiation to stabilize the impending pathologic fracture. | High probability of pathologic fracture; a score of 9 corresponds to about a 33% fracture risk (rising further with higher scores), justifying prophylactic stabilization. | Criteria/management: PMC3049613, Mirels' Staging System, Table 2 (>=9 = prophylactic fixation). Risk figure (score 9 ~33%): PMC3049613 Table 2, corroborated by PMC11941509. | ✓ |

### Citações por categoria
- **<=7**: Mirels H. Metastatic disease in long bones: a proposed scoring system (Mirels) (1989) — https://doi.org/10.1097/00003086-198912000-00027 · Criteria/management: PMC3049613, Mirels' Staging System, Table 1 (variables) and Table 2 (<=7 = irradiate/observe). Risk figure (score 7 ~4%): PMC3049613 Table 2, corroborated by PMC11941509.
- **8**: Mirels H. Metastatic disease in long bones: a proposed scoring system (Mirels) (1989) — https://doi.org/10.1097/00003086-198912000-00027 · Criteria/management: PMC3049613, Mirels' Staging System, Table 2 (8 = clinical judgment). Risk figure (~15%): PMC3049613 Table 2, corroborated by PMC11941509.
- **>=9**: Mirels H. Metastatic disease in long bones: a proposed scoring system (Mirels) (1989) — https://doi.org/10.1097/00003086-198912000-00027 · Criteria/management: PMC3049613, Mirels' Staging System, Table 2 (>=9 = prophylactic fixation). Risk figure (score 9 ~33%): PMC3049613 Table 2, corroborated by PMC11941509.


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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