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