Evidence
Last updated: 2026-02-25
Assistive-Only Disclaimer
OrthoPath is an assistive clinical decision support tool only. All evidence citations are provided for transparency and clinician review. They do not constitute clinical endorsement or replace clinical judgement.
Do not enter patient identifiers or any Protected Health Information (PHI) into this tool.
Evidence Model
Each OrthoPath module is grounded in a peer-reviewed evidence base. Every rule in a module is linked to at least one entry in that module's evidence manifest. The manifest records:
- Citation — full bibliographic reference.
- Locator — DOI, PMID, or URL.
- Year — publication year.
- Superseded — whether the evidence has been superseded by a newer source.
Evidence Sources by Module
Ottawa Ankle & Knee Imaging Rules
Primary sources include the original Ottawa Ankle Rules (Stiell et al., JAMA 1993) and Ottawa Knee Rules (Stiell et al., Ann Emerg Med 1995), their prospective validations, systematic reviews (Bachmann et al., BMJ 2003), and ACR Appropriateness Criteria (2020). Paediatric applicability is supported by Dowling et al. (2009) and Vijayasankar et al. (2009).
Regional Anesthesia & Anticoagulation
Primary source is the American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Neuraxial Anesthesia and Anticoagulation, 5th edition. Supplementary references include ESAIC/ESRA guidelines and platelet threshold studies.
Open Fracture Initial Management & Antibiotics
Primary sources include EAST Practice Management Guidelines, BOAST/BSSH guidelines, published RCTs and systematic reviews on antibiotic prophylaxis in open fractures, and ACIP tetanus prophylaxis recommendations.
Pathologic Fracture Risk & Treatment (Mirels)
Primary source is Mirels (1989), which proposed the scoring system for diagnosing impending pathologic fractures in metastatic long-bone lesions (site, pain, lesion type, size). Supporting evidence includes Damron et al. (2003) and Van der Linden et al. (2003) on predictive validity; ASTRO Evidence-Based Guideline (Lutz et al., 2017) for palliative radiation; and literature on operative management and preoperative embolization (e.g. Fuchs et al., Snyder et al., Chatziloannou et al.). The module uses risk tiers (low / intermediate / high) to support assistive suggestions for observation, radiotherapy, or prophylactic fixation with postoperative RT.
Limitations
- Evidence is current as of the "Last updated" date for each module.
- Clinical guidelines evolve; evidence manifests will require periodic review and updating.
- The evidence manifest covers rules only — it does not capture all literature related to a clinical topic.
- Superseded evidence entries are retained for audit purposes but are not used as the primary basis for current rules.