Pediatric Orthopedics

Among the many important decisions that general pediatricians must make on a daily basis are those depending on the recognition of conditions requiring timely referral to pediatric orthopedic surgeons. This year the Surgical Advisory Panel of the American Academy of Pediatrics issued an important policy statement identifying a range of conditions requiring timely referral to pediatric surgical specialists, including pediatric orthopedic surgeons. At the same time, it is equally important that pediatricians receive the training to recognize those disorders that they can—and should—be comfortable handling without involving pediatric orthopedic specialists. Such competence at the primary care level is important for the child, for his or her family, for the pediatrician, and for the pediatric orthopedic specialist.

Over the past decade, several surveys of children referred by pediatricians to pediatric orthopedic surgeons have found evidence suggesting that approximately half of such referrals are inconsistent with the guidelines recommended by the Surgery Advisory Panel of the American Academy of Pediatrics ; that is, about half of the children referred had conditions that pediatricians should be comfortable assessing and managing.

It is the purpose of this issue to review conditions that are likely to present to pediatricians to update them as to the appropriate evaluation and treatment algorithm—including both management in their own offices and appropriate referrals. The articles in this issue are written for pediatricians and therefore are centered on the symptoms and concerns that might bring the child to their attention. The articles provide guidance as to the workup and evaluation of these children, including guidance as to what conditions and findings or constellations thereof need to be referred and when. It provides insightful guidance combining practical advice and major advances in the field.

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