Choosing Wisely: Some Tests May Be Unnecessary for Young Orthopaedics Patients

Shared by Nick Rajacich, MD
Mary Bridge Children’s Orthopedics, from the AAP and the Pediatric Orthopedic Society of North America (POSNA)
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The American Academy of Pediatrics (AAP), and the Pediatric Orthopedic Society of North America, as part of the Choosing Wisely® campaign, recently released a list of specific orthopaedic tests and procedures that are commonly ordered but not always necessary when treating children for hip, foot and other musculoskeletal conditions.

Unnecessary testing often generates false positive findings that can lead to more testing, expense, inconvenience for patient and family, and even to painful invasive diagnostic or therapeutic procedures. 

The Choosing Wisely recommendations include:

  • Do not order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip location if the baby has no risk factors or physical findings.
  • Do not order radiographs or advise bracing or surgery for a child under age 8 who has a mild in-toeing gait, which usually reflects an ongoing maturation of the skeleton.
  • Do not order custom orthotics or shoe inserts for a child with mild flat feet. If an arch is present when standing on tiptoe, the foot can be managed with observation or over-the-counter orthotics.
  • Do not order advanced imaging studies, such magnetic resonance imaging (MRI) and computerized tomography (CT) for most musculoskeletal conditions until all appropriate clinical laboratory and radiographic examinations have been completed.
  • Follow-up X-rays for buckle (or torus) fractures of the forearm are unnecessary if the injury is no longer tender or painful. These fractures often do not require a formal cast but instead may be immobilized with a simple wrist brace or removable splint.