Imaging and Clinical Findings
In the absence of reliable evidence, it is the opinion of the workgroup that the combination of imaging findings and lesion-related pain is predictive of risk of pathologic femur fracture. There is no reliable evidence to suggest that MRI is a strong predictor of femur fracture.


Although advanced 3-dimensional imaging, multi-plane x-rays, and combinations of studies, including PET scanning (Ulaner, 2017) can demonstrate radiographic depictions of the damage caused by metastatic lesions to the proximal femur, the available literature fails to define specific parameters that can accurately predict fracture risk. Low-quality evidence (Oh, 2017; Ulaner, 2017) supports the intuitive presumption that increased bone damage in the proximal femur is associated with an increased fracture risk. Furthermore, although MRI evaluation can accurately demonstrate the intra and extraosseous extent of lesions, there is no reliable evidence that this modality can be used as a predictor for fracture. Combining clinical factors, particularly tumor pain and pain with weight bearing, may aid clinicians in deciding when to intervene surgically in order to prevent a frank pathological fracture and the associated morbidities which may then occur.


The Future of OrthoGuidelines


The OrthoGuidelines Process