NOTE: Each patient’s situation is assessed by assigning a number (1, 2, or 3) to each aspect of his or her presentation (site, pain, lesion, and size) and then the numbers are added to obtain a total number to indicate the patient’s risk for fracture. Mirels data suggest that those patients whose total number is 7 or less can be irradiated and observed, but those with a number of 8 or more should have prophylactic internal fixation.

From RajaniR, QuinnRT. Pathologic fractures. In: TornettaP III, RicciWM, OstrumRF, et al., eds. Rockwood and Green’s Fractures in Adults. Vol 1. 9th ed. Philadelphia: Wolters Kluwer; 2020:729–754.