IJAJR 2019 Multiple Mieloma Radiological ImageImage commented
We show the radiological evolution of a lytic lesion of the distal humerus in 6 weeks in a 72 years-old male with multiple myeloma (Fig 1.A), developing a fracture (Fig. 1.B). Mirel´s score is valuable in order to predict the possible evolution of an impending fracture. According to this score, prophylactic fixation is recommended for a lesion with score of 9 or higher. A lesion with a score inferior or equal to 7 could be managed using radiotherapy and drugs (1). Three variables are taken into consideration. The diameter of the lesion (<1/3 of cortex, 1/3 to 2/3 of cortex and >2/3 of cortex), its nature (blastic, mixed and lytic) and the location (Upper Limb, Lower Limb and Trochanteric Region). For each variable, the score is 1, 2 or 3 accordingly and a sum is performed. This case scored 7, and was treated with radiotherapy. It can be a matter of discussion whether surgical stabilization at the beginning would have provided better limb function or not (2).
References
1. Jawad MU, Scully SP. In brief: classifications in brief: Mirels' classification: metastatic disease in long bones and impending pathologic fracture. Clin Orthop Relat Res. 2010;468(10):2825-2827.
2. Nooh A, Goulding K, Isler MH, et al. Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease. Clin Orthop Relat Res. 2018;476(3):535-545.
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Impending fracture of the distal humerus. Postnikov Y 1, Catalan M 2.
1 Department of Orthopaedic Surgery Hospital Clínic. University of Barcelona, Spain. 2 Centro de Atención Primaria Casanova. Consorcio de Atención Primaria de l ´Eixample University of Barcelona. Spain.
Abstract We present the radiological evolution of a case of impending fracture of the distal humerus. Keywords Mirel´s score, impending fracture, humerus
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Copyright
Copyright © 2019 Postnikov Y et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflicts of interest statement
The authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
How to cite
Postnikov Y, Catalan M. Impending fracture of the distal humerus. Int J Adv Jt Reconstr. 2019; 6(2): 33.
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Fig 1. A. Anteroposterior view of the left humerus, showing an extensive lytic lesion of the distal humerus; B. Evolution in 6 weeks without treatment.
A B