Scope of Practice for Pediatric Orthopaedic Medicine at a Tertiary Care Center.

Abstract

Background: Pediatric orthopaedic medicine (alternatively/formerly known as non-operative pediatric orthopaedics, NOPO) is an emerging specialty within orthopedics with limited published descriptive studies. This is a retrospective descriptive study of all patient encounters managed by three pediatric orthopedic medicine physicians at a single institution over a five-year period (2019-2024).

Methods: Data from an internal hospital database were analyzed to determine the volume of patients seen, diagnoses managed, and surgical referral patterns. A total of 31,216 patient encounters were analyzed.

Results: The top diagnoses managed by this group include: acute fracture (all body locations) 24.8% (n=15,019), scoliosis 10.9% (n=6,713), abnormal gait and mobility 7.9% (n=4,558), lower limb alignment 6.9% (n=4,176), joint disorders 6.9% (n=4,135), congenital hip deformities 5.9 % (n=3,453), congenital foot deformities 4% (n=2,442), pain, soft tissue 4% (n= 2,326), developmental delay 4 % (n=2,147), and dorsalgia 2% (n=1,173). Of the unique patients in the dataset 96% were managed medically and 4% had surgery related to their initial diagnosis. The top surgical procedures were: knee surgeries (14.8%), upper extremity pinning/reduction (14.6%), spinal fusion (7%), hip open/closed reduction (6.2%), Achilles lengthening (6.2%), Botox/phenol injection (5.9%), and lower extremity epiphysiodesis (3%).

Conclusions: Data from this study provide insight into the unique role pediatric orthopedic medicine physicians play in the pediatric orthopedic community and can help guide curriculum development for future trainees.

Key concepts: (1)Pediatric orthopaedic medicine is an emerging specialty within orthopaedics with limited published descriptive studies.(2)Pediatric orthopaedic medicine physicians manage a wide range of orthopaedic conditions traditionally managed by surgical colleagues.(3)In an increasingly specialized pediatric orthopaedic workforce, pediatric orthopaedic medicine physicians can serve as a medical home for many nonsurgical orthopaedic conditions.(4)A formal curriculum for pediatric orthopaedic medicine training should be developed with a goal toward ACGME accreditation of fellowships.

Level of evidence: Retrospective cohort study.