Pediatric Orthopedics

Preface
P e d i a t r i c Or t h o p e d i c s f o r t h e
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.1
It is second only to ophthalmology as the most common subspecialty referral.2 The
American Academy of Pediatrics guidelines recommend that cases across a very
broad range of diagnoses be referred to a pediatric orthopedic surgeon.3 These diag-
noses include benign bone tumors, congenital malformations, limb deformities, meta-
bolic 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.4
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 condi-
tions and to clarify some of the common confusions and controversies that exist.
In accordance with these principles, a survey of some pediatricians, pediatric ortho-
pedic 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 differenti-
ating causes of hip irritability in young children were thought to be important to include.

Pediatr Clin N Am 61 (2014) xiii–xiv

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xiv Preface

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.

P. Christopher Cook, MD, FRCS(C)

Golisano Children’s Hospital
University of Rochester
601 Elmwood Avenue
Box 665
Rochester, NY 14642, USA
E-mail address:
Christopher_Cook@URMC.Rochester.edu

REFERENCES

1. Schwend RM, Geiger J. Outpatient pediatric orthopedics: common and important

conditions. Pediatr Clin North Am 1998;45:943–71.
2. Vernacchio L, Muto JM, Young G, et al. Ambulatory subspecialty visits in a large
pediatric primary care network. Health Serv Res 2012;47(4):1755–69.
3. Surgical Advisory Panel. Guidelines for referral to pediatric surgical specialists.
Pediatrics 2002;110:187–91.
4. Hsu EY, Schwend RM, Leamon J. How many referrals to a pediatric orthopaedic
hospital specialty clinic are primary care problems? J Pediatr Orthop 2012;
32(7):727–31.