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.