Safety and Complications Associated With MRI-Conditional External Fixators in Patients With Tibial Plateau Fractures: A Case Series

Gillig, Jonathan D.; Goode, Russell D.; Campfield, Brian T; Crim, Julia R.; Crist, Brett D.

doi:10.1097/bot.0000000000001246

Cited by 10 publications

(35 citation statements)

References 19 publications

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“…The results of this survey are consistent with previous reports of rare minor events (such as mild warmth and vibratory sensations) having occurred in a small number of patients, but no harmful complications or any lasting consequences. 6 Despite a lack of reported complications, heat generation during MRI scanning should be taken seriously, and it is possible that some of these events resulted in delayed complications, which were not appreciated by the attending orthopaedic surgeon completing the survey. However, heat generation of three of the most common, modern external fixation constructs during MRI scanning has been recently measured and, in most cases, did not exceed 1°C.…”

Section: Discussionmentioning

confidence: 99%

External Fixator Usage and Delayed MRI Scans: A National Survey Study

Rysselberghe

Fithian

Kim

et al. 2023

J Am Acad Orthop Surg

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Objective: To report the current state of institutional protocols regarding the use of MRI in patients with external fixation devices (EFDs) in the United States. Design: National Survey Study. Participants: Practicing orthopaedic surgeons frequenting the Orthopaedic Trauma Association website were invited to participate in this study. Results: Sixty-two eligible orthopaedic surgeons completed the survey. No respondents reported any known harmful complications of MRI use with an EFD. Eight respondents (13%) reported at least one early scan termination because of mild warmth or vibration without any lasting complications. Fifty-six respondents (90%) reported delays to care related to MRI-EFD compatibility labeling, and 27 respondents (48%) reported delayed MRI scans in every patient with an EFD who needed one. Twenty-six surgeons (42%) had modified their practice in some way in response to these barriers. Examples include delaying EFD placement until after MRI, relying on CT arthrograms over MRI for surgical planning, and taking patients to the operating room to remove EFDs temporarily and then replace them. Nineteen respondents (31%) had developed formal protocols to address this issue, but having a written protocol was not associated with any decrease in delays (P = 0.119). Eighty-nine percent of respondents thought there was a need for a national consensus guideline on this issue. Conclusion: Despite no previous reports of harmful complications, MRI utilization is frequently delayed or prevented in patients with EFDs in place. This is a pervasive problem nationally, which persists despite the implementation of written institutional protocols.

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Section: Discussionmentioning

confidence: 99%

External Fixator Usage and Delayed MRI Scans: A National Survey Study

Rysselberghe

Fithian

Kim

et al. 2023

J Am Acad Orthop Surg

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“…The debate about the possibility to perform MRI in the presence of external fixator is more than 20 years old. After the safety concern has been largely investigated [ 1 , 7 , 8 , 14 ], the current discussion is about the efficacy of MRI in the presence of artifacts due to the presence of metallic component of external fixators. This study showed that, in the conditions described above, the MRI performed on instrumented legs provided images useful for more accurate diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Gillig J.D. et al reported that MRI imaging in Schatzker IV, V and VI tibial plateau fractures better visualized bone landmarks and could avoid the use of computer tomography (CT), experiencing no complications [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Once the ligamentotaxis has been obtained, the subsequent step involves computerized axial tomography (CAT scan) to assess the damage and plan for surgical definitive fixation. In daily practice, because of the nature of the injury combining bony and soft tissue alterations, orthopedic surgeons should request more often MRI scans of the knee following bridging temporary external fixation of the joint [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this classification, radiology departments considered restricting the use of MRI in the management of trauma patients implanted with external fixators for medical and legal reasons [ 14 ]. According to the orthopedic physician requiring the MRI, the final decision to perform or not perform the exam is usually ultimately made by a radiologist or a radiology technician, balancing on diagnostic benefit and potential risks of harmful effects [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Magnetic Resonance Imaging of the Knee in the Presence of Bridging External Fixation: A Comparative Experimental Evaluation of Four External Fixators, Including Dolphix®

Addevico

Simoncini

Solitro

et al. 2021

JFMK

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Performing MR investigation on patients instrumented with external fixators is still controversial. The aim of this study is to evaluate the quality of MR imaging of the knee structures in the presence of bridging external fixators. Different cadaveric lower limbs were instrumented with the MR-conditional external fixators Hofmann III (Stryker, Kalamazoo, MI, USA), Large external Fixator (DePuy Synthes, Raynham, MA, USA), XtraFix (Zymmer, Warsaw, IN, USA) and a newer implant of Ketron Peek CA30 and ERGAL 7075 pins, Dolphix®, (Citieffe, Bologna, Italy). The specimens were MR scanned before and after the instrumentation. The images were subjectively judged by a pool of blinded radiologists and then quantitatively evaluated calculating signal intensity, signal to noise and contrast to noise in the five regions of interest. The area of distortion due to the presence of metallic pins was calculated. All the images were considered equally useful for diagnosis with no differences between devices (p > 0.05). Only few differences in the quantification of images have been detected between groups while the presence of metallic components was the main limit of the procedure. The mean length of the radius of the area of distortion of the pins were 53.17 ± 8.19 mm, 45.07 ± 4.33 mm, 17 ± 5.4 mm and 37.12 ± 10.17 mm per pins provided by Zimmer, Synthes, Citieffe and Stryker, respectively (p = 0.041). The implant of Ketron Peek CA30 and ERGAL 7075 pins showed the smallest distortion area.

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Perspectives and institutional policies on patient safety and image quality regarding the use of knee-spanning external fixators in MRI: A survey study of the Society of Skeletal Radiology

Marcel,

Alaia,

Alaia

et al. 2023

Skeletal Radiol

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Safety and Complications Associated With MRI-Conditional External Fixators in Patients With Tibial Plateau Fractures: A Case Series

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 10 publications

References 19 publications

External Fixator Usage and Delayed MRI Scans: A National Survey Study

External Fixator Usage and Delayed MRI Scans: A National Survey Study

Magnetic Resonance Imaging of the Knee in the Presence of Bridging External Fixation: A Comparative Experimental Evaluation of Four External Fixators, Including Dolphix®

Perspectives and institutional policies on patient safety and image quality regarding the use of knee-spanning external fixators in MRI: A survey study of the Society of Skeletal Radiology

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