Safety and utility of magnetic resonance imaging of patients with external fixators: a systematic review.

Objectives: To systematically review the literature on all reports of magnetic resonance imaging (MRI) use in patients with external fixators and evaluate for adverse events. Data Sources: MEDLINE, Embase, and Cochrane were searched for English-language articles from January 1, 1995, to July 14, 2024. Study Selection: Studies that described MRI use in a patient with an external fixator and measured whether adverse events occurred while the patient underwent MRI were included for analysis. Data Extraction: Two reviewers independently reviewed, selected included studies, and extracted data. A third reviewer resolved any discrepancies. Data Synthesis: Six studies (Level IV evidence) were identified, including 358 MRI instances. The quality of the studies was evaluated using the Institute of Health Economics checklist for the quality appraisal of case series studies. No descriptive statistics were performed. Results: Overall, we found no reports (0.0%) of serious patient harm, including burns and changes in the stability of the external fixation. Four (1.1%) reports of patients feeling discomfort or pain led to early termination of the MRI with no long-term sequelae. Conclusions: Overall, no patient harm events were reported in our systematic review of the available literature. Further studies are recommended to help develop future guidelines on using MRI in patients with external fixation. Currently, there is no known clinical evidence to suggest that MRI is not safe in the setting of a patient with an extremity external fixator; however, this topic remains controversial. The benefits of using MRI likely outweigh potential minor risks in this patient population, and the authors recommend against blanket restrictions prohibiting the use of MRI in patients with external fixation. Level of Evidence: Therapeutic Level IV.