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Pediatric Orthopedic Practice Changing Over Time
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Posted on: 12/22/2009
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Doctors who chose to specialize in pediatric orthopedics may now find themselves dealing less with what they had been taught and more with the results of traumas and accidents, say researchers. While the work may not be all that different in basics (working with bones and muscles, as well as other soft body tissues), the overall approach is different.
When a doctor works in orthopedics and is dealing mostly with children who have been born with certain types of problems, such as clubfeet (feet turned inwards), scoliosis (curved back) and other congenital disabilities, the approach and atmosphere is different than if he or she is working with trauma victims, children who have been hurt through some sort of accident. Because this type of work environment is different, the authors of this article looked into the changing world of pediatric orthopedics, perhaps allowing newer doctors a better understanding of what the specialty is like in the 21st century.
Researchers gathered information from an operating-room database to identify orthopedic surgeries performed on children in 1998 and 1999 and compared this information for similar data gathered from 2006 and 2007 records. By comparing them, the researchers would be able to identify any differences in the number and types of surgeries that were performed. The number of surgeries increased in the second group of records (1605 in the 06-07 period, only 931 in the 98-99 period), particularly among trauma surgeries and surgeries from sports injuries. While in the first period, there were around 370 surgical trauma cases, in the second period, there were 700. In the first period, there were 16 sports surgeries but there were 112 in the second period.
Other types of surgeries were done for the following reasons: congenital, born with the disability (109 first period versus 204 second period), developmental (153 versus 262), infection (45 versus 78), neuromuscular (185 versus 176), and tumors (53 versus 73). The results mean that trauma surgeries made up 43.6 percent of the total in 06-07, up 3.8 percent from 98-99.
The types of surgery were also broken down to spinal surgeries and surgical fractures. The differences were significant in number here as well, but not as a result of trauma. Out of a total of 175 spinal surgeries in 06-07, compared with 83 in 98-99, both only had three trauma surgeries. The largest increase came from congenital, developmental and neuromuscular surgeries.
The surgical fractures were measured by the increase in percentage from the first period to the second. There was a 105 percent increase in fractures of the humerus (upper arm) above the elbow joint. There was a 150 percent increase in fractures elsewhere on the humerus. There was a 52 percent increase in forearm fractures, 211 percent increase in wrist fractures, 55 percent in femur (thigh bone) fractures, 28 percent increase in tibia (shin bone) fractures and a 220 percent increase in ankle fractures.
This type of information for both currently practicing surgeons and for medical students who may be considering what field they may want to pursue. If they have no interest in trauma surgery, then pediatric orthopedics is likely not the best choice. On the other hand, there will continue to be a need for pediatric orthopedists, so it is vital that the medical schools and internships reflect the new reality of orthopedic surgery - that which includes trauma surgeries.
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References:
Dominick Tuason, MD, et al. Urban Pediatric Orthopaedic Surgical Practice Audit: Implications for the Future of This Subspecialty. In The Journal of Bone and Joint Surgery. December 2009. Vol. 91-A. No. 12. Pp. 2992 - 2998.
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