Fig. 1.

Flowchart of our institutional strategy for procedural selection. For the decision of surgical procedure (IMN or EPR), the following factors are considered: (1) fracture pattern (impending or pathological fracture), (2) Mirels’ score (≥8 or <8), (3) fracture site (femoral head, neck, intertrochanter, subtrochanter, diaphysis, or distal), (4) number of metastases (solitary or multiple), and (5) patient’s estimated prognosis. IMN intramedullary nailing, EPR endoprosthetic reconstruction, Fx fracture, RT radiotherapy, CT chemotherapy, BP bisphosphonate