J Knee Surg 2015; 28(03): 247-254
DOI: 10.1055/s-0034-1386579
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Do Spanning External Fixators on Knee Dislocation Patients Affect the Use of MRI and Knee Stability?

Pooya Javidan
1   Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
,
Joshua Owen
2   Department of Radiology, Saint Louis University, Saint Louis, Missouri
,
Adnan Cutuk
1   Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
,
Tracy Watson
1   Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
,
Scott Kaar
1   Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri
› Author Affiliations
Further Information

Publication History

23 February 2014

25 June 2014

Publication Date:
28 July 2014 (online)

Abstract

This study sought to determine the following: (1) Does the external fixator compromise quality of imaging obtained? (2) How do findings from the evaluation under anesthesia at the time of external fixator removal compare with the initial magnetic resonance imaging (MRI) findings? This was a retrospective study of a consecutive patient series at an academic level 1 trauma center. There were 19 consecutive patients with traumatic knee dislocations and spanning external fixator applied. Each patient had a knee MRI with the external fixator in place and examination at the time of external fixator removal. A review of knee stability at the time of external fixator removal with physical examination and stress fluoroscopy were performed. Our study revealed only minor incidence of poorly visualized structures. Clinical stability was present after fixator removal in only 11 of 14 medial collateral ligament tears, 4 of 16 lateral collateral ligament tears, 1 of 19 anterior cruciate ligament tears and 3 of 19 posterior cruciate ligament tears. MRI is a useful imaging modality in the setting of knee dislocations placed in spanning external fixators. Patients' knees largely remain unstable after external fixator removal.

 
  • References

  • 1 Hoover NW. Injuries of the popliteal artery associated with fractures and dislocations. Surg Clin North Am 1961; 41: 1099-1112
  • 2 Kennedy JC. Complete Dislocation of the Knee Joint. J Bone Joint Surg Am 1963; 45: 889-904
  • 3 Quinlan AG, Sharrard WJ. Postero-lateral dislocation of the knee with capsular interposition. J Bone Joint Surg Br 1958; 40-B (4) 660-663
  • 4 Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg 2004; 12 (5) 334-346
  • 5 Levy BA, Fanelli GC, Whelan DB , et al; Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009; 17 (4) 197-206
  • 6 Levy BA, Krych AJ, Shah JP, Morgan JA, Stuart MJ. Staged protocol for initial management of the dislocated knee. Knee Surg Sports Traumatol Arthrosc 2010; 18 (12) 1630-1637
  • 7 Stannard JP, Nuelle CW, McGwin G, Volgas DA. Hinged external fixation in the treatment of knee dislocations: a prospective randomized study. J Bone Joint Surg Am 2014; 96 (3) 184-191
  • 8 Kumar R, Lerski RA, Gandy S, Clift BA, Abboud RJ. Safety of orthopedic implants in magnetic resonance imaging: an experimental verification. J Orthop Res 2006; 24 (9) 1799-1802
  • 9 Ballock RT, Hajek PC, Byrne TP, Garfin SR. The quality of magnetic resonance imaging, as affected by the composition of the halo orthosis. A brief note. J Bone Joint Surg Am 1989; 71 (3) 431-434
  • 10 King III JJ, Cerynik DL, Blair JA, Harding SP, Tom JA. Surgical outcomes after traumatic open knee dislocation. Knee Surg Sports Traumatol Arthrosc 2009; 17 (9) 1027-1032
  • 11 Mechlin M, Thickman D, Kressel HY, Gefter W, Joseph P. Magnetic resonance imaging of postoperative patients with metallic implants. AJR Am J Roentgenol 1984; 143 (6) 1281-1284
  • 12 Davis PL, Crooks L, Arakawa M, McRee R, Kaufman L, Margulis AR. Potential hazards in NMR imaging: heating effects of changing magnetic fields and RF fields on small metallic implants. AJR Am J Roentgenol 1981; 137 (4) 857-860
  • 13 Liu Y, Shen J, Kainz W, Qian S, Wu W, Chen J. Numerical investigations of MRI RF field induced heating for external fixation devices. Biomed Eng Online 2013; 12: 12
  • 14 Luechinger R, Boesiger P, Disegi JA. Safety evaluation of large external fixation clamps and frames in a magnetic resonance environment. J Biomed Mater Res B Appl Biomater 2007; 82 (1) 17-22
  • 15 Davison BL, Cantu RV, Van Woerkom S. The magnetic attraction of lower extremity external fixators in an MRI suite. J Orthop Trauma 2004; 18 (1) 24-27
  • 16 Cannada LK, Herzenberg JE, Hughes PM, Belkoff S. Safety and image artifact of external fixators and magnetic resonance imaging. Clin Orthop Relat Res 1995; (317) 206-214
  • 17 Barbier O, Galaud B, Descamps S , et al; French Society of Orthopaedic Surgery and Traumatology (SoFCOT). Relevancy and reproducibility of magnetic resonance imaging (MRI) interpretation in multiple-ligament injuries and dislocations of the knee. Orthop Traumatol Surg Res 2013; 99 (3) 305-311
  • 18 Halinen J, Koivikko M, Lindahl J, Hirvensalo E. The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop 2009; 33 (6) 1733-1738
  • 19 Lonner JH, Dupuy DE, Siliski JM. Comparison of magnetic resonance imaging with operative findings in acute traumatic dislocations of the adult knee. J Orthop Trauma 2000; 14 (3) 183-186
  • 20 Potter HG, Weinstein M, Allen AA, Wickiewicz TL, Helfet DL. Magnetic resonance imaging of the multiple-ligament injured knee. J Orthop Trauma 2002; 16 (5) 330-339
  • 21 Rubin DA, Kettering JM, Towers JD, Britton CA. MR imaging of knees having isolated and combined ligament injuries. AJR Am J Roentgenol 1998; 170 (5) 1207-1213
  • 22 Twaddle BC, Hunter JC, Chapman JR, Simonian PT, Escobedo EM. MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg Br 1996; 78 (4) 573-579