Objectives. Fifteen potentially low value practices in adult orthopaedic
trauma care were previously identified in a scoping review. The aim of
this study was to synthesize the evidence on these practices. Methods.
We searched four databases for systematic reviews, randomized controlled
trials (RCTs), cohort studies and case series that assessed the
effectiveness of selected practices. Methodological quality was
evaluated using the Measurement Tool to Assess Systematic Reviews
version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal
Checklist for Case Series. We evaluated risk of bias with the Cochrane
revised tool for RCTs and the risk of bias in non-randomized studies of
interventions tool for observational studies. We summarized findings
with measures of frequency and association for primary outcomes.
Results. Of the 30,670 records screened, 70 studies were retained. We
identified high-level evidence of lack of effectiveness or harm for
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. However,
evidence was mostly based on studies of low methodological quality or
high risk of bias. Conclusion. In this review, we identified clinical
practices in orthopedic injury care which are not supported by current
evidence and whose use may be questioned. In future research we should
measure their frequency, assess practice variations and evaluate root
causes to identify practices that could be targeted for
de-implementation.
Retraction: An Often Easily Missed Injury in the Presence of Orthopaedic Trauma: A Case Series of Derived Injury
