Conclusions
We found high-level evidence that the following clinical practices for
orthopeadic injury care should be questioned: routine initial imaging of
ankle injury; orthosis for A0-A3 thoracolumbar burst fracture in
patients <60 years of age; cast or splint immobilization for
suspected scaphoid fracture negative on MRI or confirmed fifth
metacarpal neck fracture, and routine follow-up imaging for distal
radius and ankles fractures. In future research, we should measure their
frequency, assess practice variations, and evaluate root causes to
identify those for which de-implementation interventions would be
associated with the greatest benefit. If interventions targeting
de-adoption are deemed appropriate, they will need to be developed with
all stakeholders including clinical experts and patient partners to
account for the full complexity of orthopeadic trauma, such as fracture
characteristics, concomitant injuries and patient characteristics
affecting healing. The reduction of low value clinical practices in the
orthopaedic trauma population has the potential to reduce strain on
health care systems, to improve accessibility to services and to
accelerate return to daily life activities following injury.