AAP/POSNA: 5 unnecessary tests for young orthopedic patients

  • Choosing Wisely

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • The American Academy of Pediatrics (AAP), together with the Pediatric Orthopaedic Society of North America (POSNA), produced a list of 5 tests that may be unnecessary for young orthopedics patients.
  • The list was generated after careful review and receipt of input from several expert committees.

Why this matters

  • Unnecessary tests often elicit false-positive findings that can lead to more testing, expense, inconvenience, and painful invasive diagnostic or therapeutic procedures.

5 things physicians and parents should question

  • Do not order a screening hip ultrasound to exclude developmental hip dysplasia or developmental hip dislocation if the baby lacks risk factors and has a clinically stable hip exam.
  • Do not order radiographs or recommend bracing or surgery for a child younger than 8 years with simple in-toeing gait.
  • Do not order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet.
  • Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in children until after all appropriate clinical, laboratory, and plain radiographic exams have been done.
  • Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer painful or tender.

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