mirels_fracture_score: Mirels' Criteria for Prophylactic Fixation

In cliot: Clinical Indices and Outcomes Tools

Mirels' Criteria for Prophylactic Fixation

Description

Calculates the Mirels' Score to assess the risk of pathological fracture in long bones due to metastatic disease. The score evaluates four parameters: site, pain, lesion type, and lesion size. It helps determine whether prophylactic surgical fixation or radiotherapy is the appropriate management strategy.

Usage

mirels_fracture_score(site, pain, lesion_type, size_ratio)

Arguments

site	String. Location of the lesion. "upper_limb": Upper extremity (1 pt). "lower_limb": Lower extremity (2 pts). "peritrochanteric": Peritrochanteric region (3 pts).
pain	String. Severity of pain. "mild": Mild pain (1 pt). "moderate": Moderate pain (2 pts). "functional": Functional/Severe pain (3 pts).
lesion_type	String. Radiographic appearance of the lesion. "blastic": Blastic (1 pt). "mixed": Mixed (2 pts). "lytic": Lytic (3 pts).
size_ratio	String. Size of the lesion relative to the bone diameter. "lt_one_third": < 1/3 of bone diameter (1 pt). "one_third_to_two_thirds": 1/3 - 2/3 of bone diameter (2 pts). "gt_two_thirds": > 2/3 of bone diameter (3 pts).

Value

A list containing:

Mirels_Score	The calculated total score (Range 4-12).
Recommendation	Clinical guidance based on the score threshold (Fixation indicated for score >= 9).
Est_Fracture_Risk	Estimated risk of pathological fracture.

References

Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res. 1989;(249):256-264.

Examples

# Example 1: High Risk
# Peritrochanteric (3), Functional pain (3), Lytic (3), >2/3 size (3)
# Score = 12
mirels_fracture_score("peritrochanteric", "functional", "lytic", "gt_two_thirds")

# Example 2: Low Risk
# Upper limb (1), Mild pain (1), Blastic (1), <1/3 size (1)
# Score = 4
mirels_fracture_score("upper_limb", "mild", "blastic", "lt_one_third")

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