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Predicting Pathological Fractures at Metastatic Humeral Lesions

BACKGROUND: The humerus is the second most common site of metastatic disease involving long bones, yet it is still unclear which patients are at high risk for a fracture and may require prophylactic surgical fixation. The goal of this study was to assess the validity of the Mirels score to predict f...

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Autores principales: Tat, Jimmy, Bodansky, David, Sheth, Ujash, Ung, Yee, Whyne, Cari, Nam, Diane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Journal of Bone and Joint Surgery, Inc. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132712/
https://www.ncbi.nlm.nih.gov/pubmed/37123507
http://dx.doi.org/10.2106/JBJS.OA.22.00070
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author Tat, Jimmy
Bodansky, David
Sheth, Ujash
Ung, Yee
Whyne, Cari
Nam, Diane
author_facet Tat, Jimmy
Bodansky, David
Sheth, Ujash
Ung, Yee
Whyne, Cari
Nam, Diane
author_sort Tat, Jimmy
collection PubMed
description BACKGROUND: The humerus is the second most common site of metastatic disease involving long bones, yet it is still unclear which patients are at high risk for a fracture and may require prophylactic surgical fixation. The goal of this study was to assess the validity of the Mirels score to predict fractures of metastatic lesions in the humerus. METHODS: We performed a retrospective electronic chart review of patients with humeral metastases at our institution (2005 to 2021), with 188 patients meeting the inclusion criteria. Sixty-one of the patients developed a fracture during follow-up. The metastatic humeral lesions were scored according to the Mirels rating system and additional radiographic criteria (cortical breach, location within the humerus, number of lesions). The predictive value of each Mirels score cutoff for fracture was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and multivariate logistic regression. Survivorship until fracture was analyzed for each Mirels score cutoff using Kaplan-Meier curves and the log-rank test. Significance was set at p < 0.01. RESULTS: There were no significant differences in age, sex, side of the lesion, type of malignancy, and radiation dose between the groups with and without fracture (all p > 0.01). A Mirels score of ≥8 points had the best predictive profile, with sensitivity of 83.6%, specificity of 79.5%, and AUC of 0.82 (95% confidence interval [CI], 0.75 to 0.88, p < 0.01). A logistic regression model also demonstrated that a Mirels score of ≥8 (odds ratio = 5.8, 95% CI = 1.9 to 18.2, p < 0.01) and a cortical breach (odds ratio = 21.0, 95% CI = 5.7 to 77.2, p < 0.01) were significant predictors of pathological fracture. No other radiographic characteristics were found to be significant predictors of fracture. CONCLUSIONS: This study indicated that a Mirels score of ≥8 points had the best predictive profile for anticipating fractures at a metastasis in the humerus. This is in contrast to the traditional Mirels definition of an impending pathological fracture that is used for the lower extremity, a score of ≥9. Additionally, the presence of a cortical breach was a significant predictor of fracture risk. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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spelling pubmed-101327122023-04-27 Predicting Pathological Fractures at Metastatic Humeral Lesions Tat, Jimmy Bodansky, David Sheth, Ujash Ung, Yee Whyne, Cari Nam, Diane JB JS Open Access Scientific Articles BACKGROUND: The humerus is the second most common site of metastatic disease involving long bones, yet it is still unclear which patients are at high risk for a fracture and may require prophylactic surgical fixation. The goal of this study was to assess the validity of the Mirels score to predict fractures of metastatic lesions in the humerus. METHODS: We performed a retrospective electronic chart review of patients with humeral metastases at our institution (2005 to 2021), with 188 patients meeting the inclusion criteria. Sixty-one of the patients developed a fracture during follow-up. The metastatic humeral lesions were scored according to the Mirels rating system and additional radiographic criteria (cortical breach, location within the humerus, number of lesions). The predictive value of each Mirels score cutoff for fracture was assessed using sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and multivariate logistic regression. Survivorship until fracture was analyzed for each Mirels score cutoff using Kaplan-Meier curves and the log-rank test. Significance was set at p < 0.01. RESULTS: There were no significant differences in age, sex, side of the lesion, type of malignancy, and radiation dose between the groups with and without fracture (all p > 0.01). A Mirels score of ≥8 points had the best predictive profile, with sensitivity of 83.6%, specificity of 79.5%, and AUC of 0.82 (95% confidence interval [CI], 0.75 to 0.88, p < 0.01). A logistic regression model also demonstrated that a Mirels score of ≥8 (odds ratio = 5.8, 95% CI = 1.9 to 18.2, p < 0.01) and a cortical breach (odds ratio = 21.0, 95% CI = 5.7 to 77.2, p < 0.01) were significant predictors of pathological fracture. No other radiographic characteristics were found to be significant predictors of fracture. CONCLUSIONS: This study indicated that a Mirels score of ≥8 points had the best predictive profile for anticipating fractures at a metastasis in the humerus. This is in contrast to the traditional Mirels definition of an impending pathological fracture that is used for the lower extremity, a score of ≥9. Additionally, the presence of a cortical breach was a significant predictor of fracture risk. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Journal of Bone and Joint Surgery, Inc. 2023-04-27 /pmc/articles/PMC10132712/ /pubmed/37123507 http://dx.doi.org/10.2106/JBJS.OA.22.00070 Text en Copyright © 2023 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Scientific Articles
Tat, Jimmy
Bodansky, David
Sheth, Ujash
Ung, Yee
Whyne, Cari
Nam, Diane
Predicting Pathological Fractures at Metastatic Humeral Lesions
title Predicting Pathological Fractures at Metastatic Humeral Lesions
title_full Predicting Pathological Fractures at Metastatic Humeral Lesions
title_fullStr Predicting Pathological Fractures at Metastatic Humeral Lesions
title_full_unstemmed Predicting Pathological Fractures at Metastatic Humeral Lesions
title_short Predicting Pathological Fractures at Metastatic Humeral Lesions
title_sort predicting pathological fractures at metastatic humeral lesions
topic Scientific Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132712/
https://www.ncbi.nlm.nih.gov/pubmed/37123507
http://dx.doi.org/10.2106/JBJS.OA.22.00070
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