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Safety of Magnetic Resonance Imaging in Orthopaedic Trauma Patients With External Fixation: A Two-Center Case Series
Jacob S Borgida1,2, Robert Kaspar Wagner1,2, Alice W Wong1,2
1Harvard Orthopaedic Trauma Initiative, Massachusetts General Hospital, Boston, MA.
Objectives:
To report on adverse events during magnetic resonance imaging (MRI) in patients with external fixators.
Methods:
.
Design:
Retrospective case series.
Setting:
Two Level 1 trauma centers.
Patient Selection Criteria:
Patients with external fixators on the appendicular skeleton or pelvis undergoing MRI between January 2005 and September 2023.
Outcome Measures And Comparisons:
Adverse events, defined as any undesirable event associated with the external fixator being inside or outside the MRI bore during imaging, including (subjective) heating, displacement or pullout of the external fixator, or early MRI termination for any reason.
Results:
A total of 97 patients with 110 external fixators underwent at least one MRI scan with an external fixator inside or outside of the MRI bore. The median age was 51 years (interquartile range: 39-63) and 56 (58%) were male. The most common external fixator locations were the ankle (24%), knee (21%), femur (21%), and pelvis (19%). The median duration of the MRI was 40 minutes (interquartile range: 26-58), 86% was performed using 1.5-Tesla MRI, and 14% was performed using 3.0-Tesla MRI. Ninety-five percent of MRI was performed for the cervical spine/head. Two MRI scans (1.6%), one of the shoulder and one of the head and cervical spine, with the external fixator outside of the bore were terminated early because of patient discomfort. There were no documented events of displacement or pullout of the external fixator.
Conclusions:
These findings suggest that MRI scans of the (cervical) spine and head can be safely obtained in patients with external fixators on the appendicular skeleton or pelvis. Given the low numbers of MRI scans performed with the external fixator inside the bore, additional studies are necessitated to determine the safety of this procedure. The results from this study can aid orthopaedic surgeons, radiologists, and other stakeholders in developing local institutional guidelines on MRI scanning with external fixators in situ.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Insights
Magnetic resonance imaging (MRI) is safe for patients with external fixators on limbs or pelvis, especially for spine and head scans. Further research is needed for fixators inside the MRI bore.
Area of Science:
- Orthopedic Surgery
- Radiology
- Medical Imaging
Background:
- External fixators are used for orthopedic injuries.
- Magnetic resonance imaging (MRI) is a crucial diagnostic tool.
- Concerns exist regarding MRI safety with external fixators due to potential adverse events.
Purpose of the Study:
- To evaluate adverse events during MRI in patients with external fixators.
- To assess the safety of MRI scans in patients with external fixators on the appendicular skeleton or pelvis.
Main Methods:
- Retrospective case series conducted at two Level 1 trauma centers.
- Included patients with external fixators on appendicular skeleton or pelvis undergoing MRI.
- Adverse events included heating, displacement, pullout, or early MRI termination.
Main Results:
- 97 patients with 110 external fixators underwent MRI.
- Most scans were 1.5-Tesla for the cervical spine/head.
- Only 1.6% of scans (external fixator outside bore) were terminated early due to patient discomfort; no fixator displacement or pullout occurred.
Conclusions:
- MRI of the spine and head with external fixators in situ appears safe.
- Further studies are required to assess safety with external fixators inside the MRI bore.
- Findings can inform institutional guidelines for MRI in patients with external fixators.
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