The 5 pediatric musculoskeletal procedures parents and physicians should question

Shayna Korol -   Print  |

The American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America identified five procedures that may be unnecessary when evaluating pediatric patients with musculoskeletal symptoms. The groups published the list as part of the American Academy of Pediatrics' Choosing Wisely campaign.

Here are the "five things physicians and patients should question."


1. Ordering a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination. Hip dysplasia or dislocation is relatively rare, with incidence of approximately seven per 1,000 births. Universal screening programs for developmental hip instability have a substantial false positive rate and associated increased treatment rate, suggesting that babies without hip problems are being treated for them.


2. Ordering radiographs or advising bracing or surgery for a child under eight with simple in-toeing gait. Mild in-toeing usually reflects ongoing skeletal maturation. Simply monitoring gait for improvement at normal well child examination intervals is adequate until the age of seven or eight unless there is severe tripping, falling or asymmetry.


3. Ordering custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet. Flexible flat feet are a normal variation. If an arch is present when standing on tiptoe, the foot can be managed with observation or over-the-counter orthotics.


4. Ordering MRI or CT scans for most musculoskeletal pediatric conditions until all appropriate clinical, laboratory and plain radiographic examinations have been completed.


5. Ordering follow-up X rays for torus fractures if they are no longer painful or tender. Torus fractures, especially in the distal radius, are very common in young children. They do not necessarily require a formal cast unless severe pain or instability requires a cast for four weeks.


More articles on orthopedics:

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Dr. Yair Kissin performs N.J.'s first robotic-assisted TKR surgery using TSolution One System: 4 things to know

Orthopedic surgeon to know: Dr. Mary O'Connor of Yale School of Medicine

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