Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures

Abstract

This paper proposes a weighted scoring system to quantify the risk of sustaining a pathologic fracture through a metastatic lesion in a long bone. This system objectively analyzes and combines four radiographic and clinical risk factors into a single score. Seventy-eight metastatic tumours treated with radiotherapy but without prophylactic surgical fi xation were analysed retrospectively. Clinical data and radiographs were scored prior to irradiation by independent observers. The authors identifi ed 51 lesions that did not fracture during the subsequent 6 months and 27 lesions that fractured within 6 months. The non-fracture group had a mean score of 7, whereas the fracture group had a mean score of 10. For any given score, the risk of a lesion leading to a pathologic fracture could be determined. As the score increased above 7, so did the risk of fracture. The authors suggested that all metastatic lesions in long bones should be evaluated prior to irradiation. Lesions with scores of 7 or lower can be safely irradiated without risk of fracture, while lesions with scores of 9 or higher require prophylactic internal fixation prior to irradiation.