title: Comparative analysis of risk factors for pathological fracture with femoral metastases.
abstract: A number of risk factors based upon mostly retrospective surgical data, have been formulated in order to identify impending pathological fractures of the femur from low-risk metastases. We have followed up patients taking part in a randomised trial of radiotherapy, prospectively, in order to determine if these factors were effective in predicting fractures. In 102 patients with 110 femoral lesions, 14 fractures occurred during follow-up. The risk factors studied were increasing pain, the size of the lesion, radiographic appearance, localisation, transverse/axial/circumferential involvement of the cortex and the scoring system of Mirels. Only axial cortical involvement >30 mm (p = 0.01), and circumferential cortical involvement >50% (p = 0.03) were predictive of fracture. Mirels' scoring system was insufficiently specific to predict a fracture (p = 0.36). Our results indicate that most conventional risk factors overestimate the actual occurrence of pathological fractures of the femur. The risk factor of axial cortical involvement provides a simple, objective tool in order to decide which treatment is appropriate.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Y M
authors.initials: YM
authors.lastname: Van der Linden
authors.forename: P D S
authors.initials: PD
authors.lastname: Dijkstra
authors.forename: H M
authors.initials: HM
authors.lastname: Kroon
authors.forename: J J
authors.initials: JJ
authors.lastname: Lok
authors.forename: E M
authors.initials: EM
authors.lastname: Noordijk
authors.forename: J W H
authors.initials: JW
authors.lastname: Leer
authors.forename: C A M
authors.initials: CA
authors.lastname: Marijnen
mesh_terms: D005260:Female; D005264:Femoral Fractures / Q000209:etiology*; D005266:Femoral Neoplasms / Q000150:complications* / Q000532:radiotherapy / Q000556:secondary*; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012720:Severity of Illness Index