Orthopaedic Trauma The Royal College of Paediatrics and Child Health report Commissioning Tertiary and Specialised Services for Children and Young People (2004) states that ‘approximately one in four children each year will attend an emergency department with an injury and a significant proportion of these will require orthopaedic referral and management’.
The report goes on to say that there should be an orthopaedic surgeon responsible for the care of children within each district general hospital setting and that colleagues should form a rota to manage the more common children’s fractures. It notes that 50% of children’s fractures are to the forearm and can be safely managed in a regional or local hospital. The orthopaedic surgeon requires inpatient paediatric support, a separate ward for children, an appropriately trained anaesthetist to administer a safe anaesthetic for the fractures to be treated, appropriately trained nurses on the ward, and an appropriately trained physiotherapist to aid rehabilitation.
The management of uncomplicated paediatric orthopaedic trauma, e.g. sprains, strains and simple fractures, traditionally has been undertaken:
a. by general practitioners; and/or
b. by emergency physicians and general orthopaedic surgeons
The management of more severe paediatric orthopaedic trauma is managed at the local Level II/III orthopaedic
centres. All orthopaedic surgeons in Ireland are appropriately trained in the management of both adult and children’s trauma. Children with multiple injuries requiring paediatric intensive care unit (PICU) beds or children with simple trauma with associated complex co-morbidity are transferred to a tertiary paediatric centre.