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Normal variants in the paediatric orthopaedic population
D Molony1, G Hefferman, M Dodds
1Department of Orthopaedics, Children's University Hospital, Temple Street, Dublin 1.
Insights
Many children referred to pediatric orthopaedic clinics have normal lower limb variations, not true pathology. This highlights a need for strategies to reduce unnecessary referrals and conserve resources.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
- Clinical Medicine
Background:
- Parental concern over normal lower limb development variations frequently leads to pediatric orthopaedic referrals.
- These referrals can strain clinic resources and time.
- Distinguishing normal variations from true pathology is crucial for efficient patient management.
Purpose of the Study:
- To quantify the proportion of new referrals to a pediatric orthopaedic clinic that represent normal developmental variations.
- To identify common normal variations leading to referrals.
- To assess the rate of true pediatric orthopaedic pathology among new referrals.
Main Methods:
- Analysis of referral letters and case notes for new patients over a three-month period.
- Categorization of referrals based on the primary reason for consultation.
- Documentation of cases with confirmed true orthopaedic pathology.
Main Results:
- Normal variations in anatomy and physiology constituted 53.1% of all new referrals.
- Intoeding and flexible flat feet were the most frequent reasons for referral in the normal variation category.
- True primary pediatric orthopaedic pathology was identified in only 16.3% of new referrals.
Conclusions:
- A significant majority of new referrals to pediatric orthopaedic clinics are due to normal developmental variations, not pathology.
- These non-pathological referrals consume valuable clinical time and resources.
- Developing strategies to minimize referrals for normal variations is essential for optimizing pediatric orthopaedic services.
Abstract:
Normal variations of lower limb development are a common source of parental concern and are commonly referred to paediatric orthopaedic clinics. To determine the proportion of children referred to a paediatric orthopaedic outpatients with potentially normal developmental variations, referral letters and case notes of children attending the paediatric orthopaedic clinic at our institution over three months were analysed and categorized according to the main reason for referral. The number with true orthopaedic pathology was documented. Variations of normal anatomy and physiology accounted for 53.1% of all new referrals seen at the clinic with intoeing and flexible flat feet being the commonest referrals in this category. The rate of true primary pathology was only 16.3%. Normal developmental variations form a significant proportion of all new referrals to paediatric orthopaedic clinics. These take time and resources to process. Strategies to minimise these referrals are needed.
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