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

Abstract

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. Additional research is needed, potentially at the national level, to address this common issue. Level of Evidence: V