Pediatric Orthopaedic Surgery Rotation Objectives
UT Southwestern Medical Center
Children's Medical Center
Texas Scottish Rite Hospital

1. The Pediatric Orthopaedic Surgery rotation consists of one six-month rotation during the resident's PGY 3 year which is spent primarily at Texas Scottish Rite Hospital for Children. Additionally, PGY 3 and PGY 4 residents do participate in the care of pediatric patients at Children's Medical Center at Dallas. This exposure consists of one to two month rotations during the PGY 3 year, while assigned at TSRH, as well as night call requirements and a two month rotation at CMC as a PGY 4.
    
   The expectation of the junior resident is that they can elicit a history and physical, order appropriate diagnostic studies, and arrive at a differential diagnosis for the conditions evaluated. The junior resident should be well versed in the appropriate anatomy and should understand the basic surgical principles involved in less complex cases.
    
   The expectation of the senior resident is that they meet all of the criteria of the junior resident as well as independently develop and implement a surgical and perioperative plan for the management of these patients. At the completion of training, the senior resident should be adept enough to supervise more junior level trainees in the appropriate management of pediatric patients.
2. Acute Pediatric Orthopaedic Conditions
   1. Residents will be proficient in evaluating the limping child. This includes the ability to discuss the etiology, pathoanatomy, treatment options, and surgical indications, as well as show proficiency in non-complex surgical techniques, of the following conditions:
      1. Osteomyelitis
      2. Septic arthritis
      3. Transient synovitis
      4. Leukemia
      5. Chronic recurrent multi-focal osteomyelitis
      6. Discitis
      7. Juvenile inflammatory arthritis
   2. The polytraumatized child — Residents will be able to evaluate and prioritize treatment involved in polytrauma including general resuscitation as well as temporary and definitive treatment of fractures of the pelvis, spine and long bones.
   3. Isolated trauma — Residents will be proficient in the evaluation and management of:
      1. Elbow fractures
         1. Supracondylar humerus
         2. Lateral condyle fractures
         3. Radial head fractures
         4. Nurse maid's elbow
      2. Isolated fractures of the long bones
      3. Physeal fractures: Residents will be familiar with the classification of physeal injuries as well as the treatment and potential complications of fractures involving the physis, with particular attention to:
         1. Salter-Harris classification
         2. Fractures of the distal radial physis
         3. Fractures of the distal femoral physis
         4. Fractures of the distal tibial physis
         5. Fractures involving the proximal femoral physis
   4. Slipped capital femoral epiphysis — Residents will be proficient in the evaluation, classification and management of slipped capital femoral epiphysis. This includes acute management with an emphasis on avoidance of complications, as well as management of complications and their late sequale.
3. Non-Acute Pediatric Orthopaedics:
   1. A. Benign rotational abnormalities — Residents will be proficient in differentiating the following:
      1. Intoeing, including the diagnosis of:
         1. Metatarsus abductus
         2. Internal tibia torsion
         3. Femoral anteversion
      2. Out toeing, including the diagnosis of:
         1. External tibial torsion
         2. Femoral retro version
   2. Hip — Residents should be proficient in discussing the natural history, etiology, pathoanatomy, non-surgical and surgical treatment options, and surgical indications as well as show proficiency in non-complex surgical techniques for the following conditions:
      1. Developmental dysplasia of the hip
         1. Idiopathic
         2. Teratologic, including neuromuscular and "syndrome related"
      2. Legg-Calve Perthes disease
      3. Idiopathic Coxa Vara
      4. Idiopathic chondrolysis
      5. Potrussio acetabulum
   3. C. Knee — Residents should be proficient in discussing the natural history, etiology, pathoanatomy, non-surgical and surgical treatment options, and surgical indications as well as show proficiency in non-complex surgical techniques for the following conditions:
      1. Osgood-Schlatter's
      2. Osteochondritis dessicans
      3. Discoid meniscus
      4. Physiologic genu valgum
      5. Physiologic genu varum
      6. Infantile and adolescent Blount's
   4. Foot — Residents should be proficient in discussing the natural history, etiology, pathoanatomy, non-surgical and surgical treatment options, and surgical indications as well as show proficiency in non-complex surgical techniques for the following conditions:
      1. Club feet
      2. Metatarsus adductus
      3. Calcaneal valgus
      4. Vertical talus
      5. Flexible flat feet
      6. Tarsal coalition
      7. Accessory navicular
      8. Adolescent bunions
   5. Spine — Residents should be proficient in discussing the natural history, etiology, pathoanatomy, non-surgical and surgical treatment options, and surgical indications as well as show proficiency in non-complex surgical techniques for the following conditions:
      1. Scoliosis
         1. Congenital
         2. Neuromuscular, including cerebral palsy, spina bifida, muscular dystrophy, and "syndromic"
         3. Idiopathic
            1. Infantile
            2. Juvenile
            3. Adolescent
      2. Spondylolysis and Spondylolisthesis
4. Residents will be proficient in discussing the natural history, etiology, medical and orthopaedic manifestations, including non-surgical and surgical treatment, for the following conditions:
   1. Cerebral Palsy
   2. Spina Bifida
   3. Muscular dystrophy
      1. Duchenne's muscular dystrophy
      2. Becker's muscular dystrophy
      3. Congenital myotonic dystrophy
   4. Down's syndrome
   5. Arthrogryposis
   6. Osteogenesis imperfecta
5. Pathology — Residents will be able to formulate a differential diagnosis and implement an evaluation plan for the following conditions:
   1. Unicameral bone cyst
   2. Aneurysmal bone cyst
   3. Nonossifying fibroma
   4. Fibrous dysplasia
   5. Eosinophilic granuloma
   6. Giant cell tumor
   7. Osteomyelitis
   8. Chondroblastoma
   9. Enchondromatosis
   10. Osteochondromatosis
   11. Ewing's sarcoma
   12. LOsteogenic sarcoma

last edited: June 12, 2008