1 | 2 | 3 | |
Location | Upper extremity | Lower extremity | Intertrochanteric |
Radiographic appearance | Blastic | Mixed | Lytic |
Sizea | < 1/3 | 1/3 - 2/3 | >2/3 |
Pain | Mild | Moderate | Functionalb |
a Size is determined as a fraction of the cortical thickness.
b Functional pain is defined as severe pain or pain aggravated by limb function. |
Score | Fracture Risk | Recommendation |
≥9 | 33%-100% | Prophylactic fixation is recommended |
=8 | 15% | Clinical judgment should be used |
≤7 | <4% | Observation and radiation therapy can be used |
As an example, the lytic, intertrochanteric lesion shown above takes up >2/3 of the cortical thickness, getting an overall score of 9 in the absence of any clinical information about the degree of pain.
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