This study asks whether the Mirels scoring system — a 4-variable weighted tool originally developed for femoral metastatic lesions — is valid and reproducible when applied specifically to humeral metastases. Thirty-nine physicians across five specialty groups scored 17 humeral cases via web-based survey; predictions were validated against actual fracture outcomes in 12 non-prophylactically treated patients.
When evaluating a humeral metastatic lesion for prophylactic fixation, use 7 points as your Mirels threshold rather than the original 9 — a score of 9+ will miss the majority of humeral fractures that will actually occur, while ≥7 captures ~80% of true impending fractures, accepting that roughly two-thirds of lesions you flag will not fracture.
This study asks whether the Mirels scoring system — a 4-variable weighted tool originally developed for femoral metastatic lesions — is valid and reproducible when applied specifically to humeral metastases. Thirty-nine physicians across five specialty groups scored 17 humeral cases via web-based survey; predictions were validated against actual fracture outcomes in 12 non-prophylactically treated patients.
When evaluating a humeral metastatic lesion for prophylactic fixation, use 7 points as your Mirels threshold rather than the original 9 — a score of 9+ will miss the majority of humeral fractures that will actually occur, while ≥7 captures ~80% of true impending fractures, accepting that roughly two-thirds of lesions you flag will not fracture.