Finite element analysis potentially identifies nonessential prophylactic stabilization in femurs with metastatic disease

Metastatic bone disease (MBD) is often managed by non-specialized orthopedic surgeons who rely on Mirels’ criteria to predict pathologic fracture risk. However, low specificity of Mirels’ criteria implies many lesions are scored at high fracture risk when the actual mechanical fracture risk is minim...

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Bibliographic Details
Published in:Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine Journal of engineering in medicine, 2022-09, Vol.236 (9), p.1297-1308
Main Authors: Johnson, Joshua E, Goetz, Jessica E, Brouillette, Marc J, Miller, Benjamin J
Format: Article
Language:English
Subjects:
Bone diseases
Computational mechanics
Computer applications
Criteria
Decision analysis
Decision making
Femur
Finite element method
Fractures
Health services
Mechanical properties
Metastases
Metastasis
Orthopedics
Pain
Patients
Risk
Risk management
Software
Stabilization
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Summary:Metastatic bone disease (MBD) is often managed by non-specialized orthopedic surgeons who rely on Mirels’ criteria to predict pathologic fracture risk. However, low specificity of Mirels’ criteria implies many lesions are scored at high fracture risk when the actual mechanical fracture risk is minimal. Our goal was to retrospectively compare mechanical fracture risk in MBD patients to Mirels’ score and clinical treatment received. Using a CT-based finite element (FE) model of the proximal femur affected by MBD, femur strength and load-to-strength ratio (LSR) were determined for 52 femurs from 48 patients. Associations of femur strength with pain and Mirels’ scores (Pearson r/Spearman ρ correlations), and the decision to operate (percentile analysis), and associations of LSR with pain and Mirels’ scores (Spearman correlations) were determined. Nineteen of 52 femurs (37%) had a very low computed mechanical fracture risk (LSR 
ISSN:0954-4119
2041-3033
DOI:10.1177/09544119221109740