MRI safe lower limb traction techniques: a systematic review and novel economic technique

To systematically review existing MRI-safe lower limb traction methodology and describe a simple, accessible technique that provides an economically viable alternative to specialized equipment.

Embase, Emcare, HMIC, Medline, and Ovid Journal databases were queried without time or language limitations (registered protocol INPLASY2025100045). Studies with lower limb traction-enhanced MRI were included, studies without traction methodology were excluded. The novel MRI-safe-traction setup consisted of a pillow "traction-hill" supporting the leg, a rolled-up blanket fulcrum and saline weights. In-line traction forces were experimentally measured at different weights and "traction-hill" angles.

Included studies (n = 31; 22 hip, 6 ankle, 4 knee, 1 foot; 2321 joints total) demonstrated 4 main types of MRI-safe-traction methods. Custom components were common (n = 24), bias and traction method reporting completeness varied. Excluded studies (n = 31) mainly lacked traction-enhanced MRIs (n = 16) or traction method description (n = 11). The described novel technique provided adequate pain relief and satisfactory MRI image quality for a paediatric midshaft femoral fracture patient. Mechanical in-line traction force validation was at least equal to or greater than the suspended weight.

A wide variety of approaches exist for MRI-safe lower limb traction, many relying on custom or special kit. We have described a successful compact MRI-safe lower limb traction setup utilizing only commonly available items, enhancing accessibility.