Paediatric Orthopaedics: A System of Decision-Making

Abstract

Paediatric orthopaedics as a speciality is in a time of transition. There is a focus on subspecialisation within paediatrics but, at the same time, there are proponents of site-specific involvement by adult regional surgeons, for example, knee reconstruction. This important text is a timely reminder that the management of paediatric orthopaedic conditions requires clinical decision-making in the context of the whole child and not just specific technical surgery. As such it is a much welcomed and strategically important contribution. This is particularly the case since in recent times there has been almost an explosion of paediatric orthopaedic text books. This book, however, is very different and I predict will be a mandatory reference in the out-patient department mainly for residents and fellows but also as a teaching aid for specific cases. The book focuses on clinical problems within regional pathology and here lies the book’s success. Limb deficiencies are grouped together and sensible consensus-based management approaches co-ordinated. Problems are highlighted and all the text augmented as indeed is the case throughout the book by a single colour tone (blue) table and illustrational construct. Limb-length discrepancy similarly addresses all four limbs in a single section. Controversially, perhaps, there is no single chapter on cerebral palsy but a masterful approach to ‘paralyses’ in general. Here, the ethos of decision making, clinical features and treatment recommendations provide seminal instructional material. Wherever the reader seeks information, the decision-making process is safe. The account of septic arthritis may not be the most comprehensive but it is a perfect vignette of decision resolution that often causes severe clinical tension, particularly for residents. Again, the sections are adequately referenced but do not provide a full literature review – the message is in the text and the tables. Senior surgeons will find this book invaluable as a prompt for clinical teaching in the clinic. At present, this text is the most informative and practical summary of paediatric orthopaedics available; as an adjunct to the standard texts, it should be unreservedly recommended.