Ward, W. Timothy; Rihn, Jeffrey A.
December 2006
Journal of Bone & Joint Surgery, American Volume;Dec2006, Vol. 88-A Issue 12, p2759
Academic Journal
Background: National data documenting the impact of pediatric trauma in general and of pediatric orthopaedic trauma in particular on the rates of hospital admissions and emergency-room visits have been reported. This study documents the frequency of and work involved in the care of pediatric orthopaedic trauma by a single urban pediatric orthopaedic group practice. Methods: The computerized billing records of a single practice group of 3.4 full-time-equivalent, fellowship-trained pediatric orthopaedic surgeons practicing in a freestanding pediatric hospital with a level-I trauma center were analyzed for one year (from July 2004 through June 2005). Every office visit and operative procedure was specifically sorted to determine the component of trauma care in the groups pediatric orthopaedic practice. Descriptive statistics, including the actual numbers and percentages of office fracture visits and operations for fracture care as well as the actual numbers and percentages of work relative value units generated by the physicians, are presented. Results: The practice generated 36,771 work relative value units, with 18,693 units (51%) from treatment provided in the operating room and 18,078 units (49%) from treatment provided in the office. A total of 1903 new fractures was seen and accounted for 5698 work relative value units (32% of all work relative value units for treatment provided in the office). The four fractures that were most frequently seen in the office were in the distal aspect of the radius (23%), forearm (14%), tibia (13%), and elbow (10%). Of the 18,693 work relative value units generated in the operating room, 5975 (32%) were from fracture care, representing the largest single category of work done in the operating room. Trauma-related operations were most commonly done for fractures of the elbow (25.3%), tibia (12%), femur (9.8%), forearm (5.5%), and the distal aspect of the radius (5%). Technically demanding fixation techniques, which are commonly used to treat fractures in adults, were frequently used, particularly for femoral and tibial fractures. Conclusions and Clinical Relevance: This study documents the frequency and work relative value of the care of musculoskeletal injuries in an urban pediatric orthopaedic practice in the outpatient and inpatient settings. It is a snapshot in time of current trends in pediatric orthopaedic practice, but these data may have implications for future resource allocation of the pediatric orthopaedic manpower in North America.


Related Articles

  • Management of the Pediatric Pulseless Supracondylar Humeral Fracture: Is Vascular Exploration Necessary? Weller, Amanda; Garg, Sumeet; Noelle Larson, A.; Fletcher, Nicholas D.; Schiller, Jonathan R.; Kwon, Michael; Copley, Lawson A. B.; Browne, Richard; Ho, Christine A. // Journal of Bone & Joint Surgery, American Volume;11/6/2013, Vol. 95-A Issue 21, p1906 

    Background: Radically different conclusions exist in the pediatric orthopaedic and vascular literature regarding the management of patients with a pink hand but no palpable radial pulse in association with a supracondylar humeral fracture. Methods: One thousand two hundred and ninety-seven...

  • The injured child in Africa. Hardcastle, Timothy C. // Journal of Emergencies, Trauma & Shock;Jan2012, Vol. 5 Issue 1, p62 

    The author discusses the accessibility of trauma medical services in Africa, particularly for pediatric cases. He is critical on the lack of recognition by governments in lower and middle income countries (LMIC) on the preventable aspect of traumatic conditions. He believes that the development...

  • Pediatric Trauma Centers. Wesson, David E. // Texas Heart Institute Journal;2012, Vol. 39 Issue 6, p871 

    The article focuses on pediatric trauma centers (PTCs). The importance of PTCs are highlighted in line with the fact that injuries are still the leading cause of death of children in the U.S. It traces the history of trauma centers and trauma systems. It outlines the criteria that a PTC should...

  • Pediatric trauma in sub-Saharan Africa: Challenges in overcoming the scourge. Ademuyiwa, Adesoji O.; Usang, Usang E.; Oluwadiya, Kehinde S.; Ogunlana, Dare I.; Glover-Addy, Hope; Bode, Chris O.; B. Van A. S, Arjan // Journal of Emergencies, Trauma & Shock;Jan2012, Vol. 5 Issue 1, p55 

    All over the world, pediatric trauma has emerged as an important public health problem. It accounts for the highest mortality in children and young adults in developed countries. Reports from Africa on trauma in the pediatric age group are few and most have been single center experience. In many...

  • Childhood injuries in Tehran: a review of 1281 cases. Karbakhsh, Mojgan; Zargar, Moossa; Zarei, Mohammad Reza; Khaji, Ali // Turkish Journal of Pediatrics;2008, Vol. 50 Issue 4, p317 

    Childhood injuries cause significant mortality and morbidity in Iran, like in other developing countries. This study was undertaken to describe the pattern of pediatric trauma in a multi-center hospital-based study. Pre-hospital and hospital data were prospectively gathered on all hospitalized...

  • `Adult' trauma surgeons with pediatric commitment: A logical solution to the pediatric trauma... D'Amelio, L.F.; Hammond, J.S. // American Surgeon;Nov95, Vol. 61 Issue 11, p968 

    Investigates the possibility of using adult surgeons in pediatric trauma care as a solution to manpower shortage. Annual ratio of injured patient for every pediatric surgeon; Experimental procedure; Use of nonoperative protocols for solid organ injury; Application of Major Trauma Outcome Study...

  • TIBIAL SPINE AVULSIONS IN THE SKELETALLY IMMATURE. Vermesan, D.; Prejbeanu, R.; Haragus, H.; Vermesan, S.; Damian, G. // Jurnalul Pediatrului;Jul-Dec2012, Vol. 15 Issue 59/60, p59 

    In children, displaced avulsions of the tibial spine are equivalent to ruptures of the anterior cruciate ligament. They present to general orthopaedists as well as a wide variety of orthopedic subspecialty surgeons including sports medicine and pediatrics. Restoration of normal knee kinematics...

  • The Soft tissue management of children's open tibial fractures. Stewart, K.J.; Tytherleigh-Strong, G.; Bharathwaj, S.; Quaba, A.A. // Journal of the Royal College of Surgeons of Edinburgh;Feb99, Vol. 44 Issue 1, p24 

    Reviews a series of 49 children admitted with a diagnosis of open tibial fracture with particular regard to soft tissue management. Grouping according to the Gustilo classification; Management by early lavage and debridement under general anesthesia, followed by immobilization; Local...

  • Stress fractures in children: a review of 37 cases. Papadimitriou, Nikolaos G.; Christophorides, John; Papadimitriou, Angeliki; Beslikas, Theodoros A.; Ventouris, Thrasos N.; Goulios, Basilios A. // European Journal of Orthopaedic Surgery & Traumatology;Mar2007, Vol. 17 Issue 2, p131 

    Stress fractures are uncommon injury in young active children and may present diagnostic dilemmas. They may have features in common with situations like infection or tumor and early suspicion of them is critical in order to eliminate the need for costly or invasive investigations. We...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics