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

Background: External fixation devices are essential in orthopedic trauma care for stabilizing fractures and facilitating recovery. However, their presence creates unique challenges for Magnetic Resonance Imaging (MRI) due to potential image artifacts and heating effects, which may compromise diagnostic efficacy and patient safety. This study aims to evaluate the impact of external fixators on MRI image quality and to provide evidence-based recommendations for their safe and effective use.

Methods: We conducted a systematic analysis of the effects of external fixation systems during MRI. Both clinical and experimental data were reviewed, focusing on artifact size, image distortion, and potential heating of fixator components. Variables such as fixator material, orientation within the scanner, and imaging parameters were assessed to determine their influence on imaging outcomes.

Results: External fixators generated varying degrees of image artifacts, predominantly influenced by the type of material (stainless steel vs. titanium) and their position relative to the imaging plane. Titanium fixators exhibited smaller artifact profiles compared to stainless steel. Optimization of imaging parameters, including sequence selection and artifact reduction techniques, significantly mitigated distortion. No clinically significant heating was observed under standard MRI conditions.

Conclusions: External fixation devices impact MRI image quality, but their effects can be minimized with careful selection of materials and imaging protocols. Titanium fixators are preferable for reducing artifacts, and optimized imaging techniques can enhance diagnostic accuracy. These findings support the safe integration of MRI in patients with external fixation systems, advancing evidence-based orthopedic care.