Pathological fracture risk (Harrington criteria)

Last revised by Daniel J Bell on 5 Aug 2019

Harrington criteria can be used to predict which long bone skeletal metastases are at high risk of pathological fracture and should undergo prophylactic internal fixation. It preceded the Mirels classification for impending pathological fracture but has not been validated and its use is debated.


  • >50% cortical bone destruction
  • lesion >2.5 cm in size
  • pathological avulsion fracture of the lesser trochanter
  • functional pain after radiation therapy​

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