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The "Choosing Wisely" collection of treatments that providers and patients should question continues to expand—this time, into pediatric orthopedics, with the American Academy of Pediatrics (AAP) issuing a list that calls for dialing back the use of imaging, ultrasound, and orthotics.

The AAP list, developed in partnership between the AAP Section on Orthopaedics and the Pediatric Orthopaedic Society of North America, makes the following 5 recommendations:

  • Do not order 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.
  • Do not order radiographs or advise bracing or surgery for a child less than 8 years of age with simple in-toeing gait.
  • Do not order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet.
  • Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory, and plain radiographic examinations have been completed.
  • Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer painful or tender.

Launched by the American Board of Internal Medicine Foundation in 2012, "Choosing Wisely" is a collection of ineffective and overused treatments and tests that has grown to 540 recommendations from more than 80 specialty society partners. In 2014, APTA became the first nonphysician organization to contribute to Choosing Wisely when it released its list of "5 Things Physical Therapists and Patients Should Question."


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