Pediatric Orthopedics for the Primary Care Provider

P. Christopher Cook, MD, FRCS(C), Editor

It has been a great pleasure to help compile this Pediatric Orthopedic issue of the Pediatric Clinics of North America . Pediatric orthopedics has traditionally been a large part of the practice of a primary pediatric provider. Approximately 30% of problems encountered in a primary pediatric practice are related to the musculoskeletal system. It is second only to ophthalmology as the most common subspecialty referral. The American Academy of Pediatrics guidelines recommend that cases across a very broad range of diagnoses be referred to a pediatric orthopedic surgeon. These diagnoses include benign bone tumors, congenital malformations, limb deformities, metabolic bone disease, infections of the bone and joints, hip dysplasia, and others. Large numbers of musculoskeletal patients carrying a very broad range of diagnoses, coupled with a traditional perception that orthopedic education in pediatric residency is limited, makes the evaluation, treatment, and referral of these conditions often confusing and difficult. This is thought to be part of the reason that 50% of referrals to pediatric orthopedists are primary care pediatric orthopedics cases.

It is not the intention of this issue to provide an exhaustive document on the details of treatment (operative and nonoperative) of complex pediatric orthopedic problems. Rather, it is meant to afford the pediatric primary provider with updated information and a review of common pediatric orthopedic issues seen in the primary care office. In addition, it is intended to provide information of when to refer many of these conditions and to clarify some of the common confusions and controversies that exist.

In accordance with these principles, a survey of some pediatricians, pediatric orthopedic surgeons, and pediatric residents was completed to determine what might be the appropriate focus of the issue and the best topics to include. As a result, issues related to trauma that might be treated in the office, new diagnoses and treatments for hip pain in the adolescent, difficulties of knee pain, a myriad of foot problems, the natural history of rotational and angular deformities, and the difficulty in differentiating causes of hip irritability in young children were thought to be important to include. The intention is to help the primary care provider not only evaluate and treat these office conditions but also develop a sense of when to refer these patients.

Pediatric orthopedics is a very large diverse subspecialty. It has patients that range in age from 0 to 16 to 18 years. It deals with a very broad array of conditions that often affect more than the musculoskeletal system, and has patients that range from the elite athlete to those that are severely disabled and bedridden. It is hoped that this issue will help clinicians with their early evaluation and management of many of these common pediatric orthopedic conditions.

Only gold members can continue reading. Log In or Register to continue