Evidence on Initial Consultation and Therapeutic Interventions
We identified three systematic reviews of RCTs (one with meta-analysis)23,39,88, six RCTs27,55,65,73,80,81, two retrospective cohort studies30,32 and one economic evaluation67 evaluating consultation with a spine surgeon for isolated thoracolumbar fracture and immobilization for thoracolumbar burst fracture, scaphoid fracture or fifth metacarpal neck fracture (Table 3). Prospective studies30,32identified no neurological deficit up to 6 months post-injury in patients who were not evaluated by a spine surgeon in the context of an isolated T1 to L5 transverse process fracture, mostly localized in the lumbar region. Systematic reviews23,88 and RCTs27,73,80 showed either no difference or less favorable physical functioning in in patients < 60 years of age who were immobilized with an orthosis for a A0-A3 thoracolumbar burst fracture compared to controls. The same was true for patients with suspected scaphoid fracture immobilized with a cast compared to those not immobilized based on magnetic resonance imaging (MRI) findings55,65 and for patients with fifth metacarpal neck fracture immobilized with a cast or a splint compared to those in which a less restrictive approach was used (i.e. wrap).39,81