Van Rysselberghe Noelle L, Fithian Andrew T, Kim Ho Bin, Sung Jeffrey C, Chou Benjamin B, Bishop Julius A, Gardner Michael J, Lucas Justin F, Hecht Garin G
From the Department of Orthopaedic Surgery, Stanford University, Stanford, CA (Van Rysselberghe, Fithian, Kim, Bishop, and Gardner), Department of Radiology (Sung and Chou), and Department of Orthopaedic Surgery (Lucas and Hecht), Santa Clara Valley Medical Center, San Jose, CA.
J Am Acad Orthop Surg. 2023 Mar 1;31(5):239-244. doi: 10.5435/JAAOS-D-21-01023. Epub 2023 Jan 11.
To report the current state of institutional protocols regarding the use of MRI in patients with external fixation devices (EFDs) in the United States.
National Survey Study.
Practicing orthopaedic surgeons frequenting the Orthopaedic Trauma Association website were invited to participate in this study.
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.
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. Additional research is needed, potentially at the national level, to address this common issue.
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