March 2018

Pediatric Orthopedic treat­ments: “Choosing Wisely”

The American Academy of Pediatrics (AAP) has added several recommendations to limit the use of certain imaging, ultrasound, and orthotics in special circumstances in children. The list, which has been added to the broader American Board of Internal Medicine (ABIM) Choosing Wisely® campaign, was developed in partnership between the AAP Section on Orthopaedics and the Pediatric Orthopaedic Society of North America. The groups recommend that clinicians who care for children refrain from ordering the following tests and interventions:

  • Screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation in an infant who has no risk factors and has a clinically stable hip examination
  • Radiographs, bracing, or surgery for a child younger than 8 years with simple in-toeing gait
  • Custom orthotics or shoe inserts for a child with asymptomatic or minimally symptomatic flat feet
  • Advanced imaging studies such as magnetic resonance imaging or computed tomography for musculoskeletal conditions in a child until all appropriate clinical, laboratory, and plain radiographic examinations have been completed
  • Follow-up radiographs for buckle or torus fractures that are no longer painful or tender.

The American Board of Internal Medicine Choosing Wisely® campaign is designed to promote conversations between clinicians and patients by helping patients choose care that is evidence based, does not duplicate tests or procedures already received, is free from harm, and truly necessary. More than 80 specialty society partners have contributed to the list of approximately 540 recommendations.

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