The Mirels’ score is a widely utilized tool for assessing the risk of pathological fractures in patients with metastatic bone disease. This scoring system assists clinicians in estimating fracture likelihood based on clinical, radiological, and anatomical parameters, thereby guiding treatment decisions and management strategies. This review provides a comprehensive analysis of the Mirels’ score, detailing its development, clinical applications, and its role in predicting fractures across various metastatic cancers. Additionally, it discusses the score’s limitations, including its potential to over- or underestimate fracture risk, and explores recent advancements in imaging and biomarker technologies that may enhance or complement its predictive accuracy. By critically examining the existing literature, this review aims to offer a thorough understanding of the Mirels’ score’s strengths and weaknesses, while considering its future role in personalized cancer care.

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes.

Proximal femur fractures (PFF) have been widely recognised as a significant social and health issue due to their costs and their impact on patient mortality, representing one of the most common types of fracture in the elderly population. The most commonly used procedures for this type of fracture are intramedullary nailing or endoprosthesis, depending on the fracture pattern. There is limited research on dedicated surgical teams in the fields of orthopedics surgery. The purpose of this study is to evaluate the importance of having a specialised surgical nurse and the impact this can have on surgical timings. This study was conducted in a level - 2 trauma center. We evaluated all patients who underwent surgery at our hospital from January 1st, 2021, to January 1st, 2022. We divided the patients into two groups, based on the type of treatment performed, then further subdivided based on the presence or absence of a specialised surgical nurse in the operating room. A total of 167 patients were categorized into two groups: those treated with an intramedullary nail (n = 72) and those receiving an endoprosthesis (n = 95). Each group was further divided based on the presence or absence of a specialised surgical nurse. We noticed significantly shorter operative times in procedures assisted by specialised nurses: 55.37 min (σ 12.97) vs. 81 min (σ 32) for intramedullary nailing (p = 0.0001) and 80.2 min (σ 27) vs. 91.48 min (σ 27) for endoprosthesis (p = 0.04). In conclusion, surgical time has a significant impact on elderly patients undergoing surgery for hip fractures. Therefore, a specialised team, including a specialist orthopedic nurse, which helps reduce operative time, is essential.

Treatment of metastatic bone fractures could be challenging, especially in elderly oncologic patients. Recent treatment options like photodynamic nailing are a mini-invasive procedure that allows fractures stabilization and early recovery. We reviewed five studies following the PRISMA guidelines obtaining 148 patients treated with Photodynamic Bone Stabilization (PBS). Mean follow-up period after surgery was 10.5 months as reported in 4 of 5 studies (range 1.5–24 months). All patients evaluated have been treated due to metastasis from other primary tumors. IlluminOss® System demonstrated positive outcomes in the reviewed studies, decreasing mean VAS score from pre-surgery values (7.71) to post-surgery values (4.19). As reported in 3 of 5 studies evaluated, mean preoperatively MSTS score was 30.38% (27–40%), earliest postoperative MSTS was 61.59% (52–87.8%). Complications were reported in 27 patients (18.24%). Several complications were described: device rupture, thromboembolic events, aseptic dehiscence, and malunion, respectively, in 14 patients (9.45%), 3 patients (2.02%), 2 patients (1.35%), 2 patients (1.35%). Our analysis offers a preliminary overview of the outcomes and complications related to PDNs (IlluminOss® System). While classical intramedullary nailing is often linked to favorable functional outcomes, the risk of complications, such as: hardware failure, and the necessity for future hardware removal, should not be ignored. The results obtained from this analysis are promising; however, further randomized studies will be necessary to determine the superiority of the method over current treatments.