Conclusions: This study demonstrates moderate to substantial agreement between and within raters using Mirels’ score on upper limb radiographs. However, Mirels’ score had a poor ensitivity and specifity in predicting upper extremity fractures. Until a more valid scoring system has been developed, based on our study, we recommend a Mirels’ threshold of 7/12 for considering prophylactic fixation of impending upper limb pathologic fractures. This contrasts with the current 9/12 cutoff, which is recommended for lower limb pathologic fractures.

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Mirels' Score for Upper Limb Metastatic Lesions: Do We Need a Different Cutoff for Recommending Prophylactic Fixation?

🧠 Key Points:

Mirels score was originally proposed for metastatic lesions in the lower extremities; its applicability to the upper extremity has been questioned.
A score of ≥7 may be sufficient to consider prophylactic fixation in upper extremity metastases.
This was a retrospective study analyzing 138 cases.

JSES International (2022), Vol 6(4): 675–681

DOI:10.1016/j.jseint.2022.03.006