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lüll Comparative analysis of risk factors for pathological fracture with femoral metastases Van der Linden YM; Dijkstra PD; Kroon HM; Lok JJ; Noordijk EM; Leer JW; Marijnen CAJ Bone Joint Surg Br 2004[May]; 86 (4): 566-73A 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.|Female[MESH]|Femoral Fractures/*etiology[MESH]|Femoral Neoplasms/*complications/radiotherapy/*secondary[MESH]|Fractures, Spontaneous/*etiology[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Pain Measurement[MESH]|Pain/etiology[MESH]|Prognosis[MESH]|Prospective Studies[MESH]|Randomized Controlled Trials as Topic[MESH]|Risk Factors[MESH]|Severity of Illness Index[MESH] |