Abstract
There have been major changes in practice in Orthopaedics and Anaesthetics in Britain over recent years. The Royal College of Anaesthetists in Britain in its document on the provision of paediatric services stated that the anaesthetic service for children should be led by consultants who anaesthetise children regularly. This has affected the range of conditions that Orthopaedic Surgeons in District General Hospitals have been able to operate.
The Children’s Orthopaedic Group in the North West Region of England was surveyed in 1996 and 2001. Age limits for elective procedures and the range of procedures performed were analysed. The orthopaedic procedures looked at were for scoliosis, DDH / Dysplasia, Perthes’ disease, CTEV, Leg lengthening and genu varum/valgum.
The demographic map of the region was studied. This highlighted the variation in Children’s Orthopaedic Services in the region. Some large population centres had minimal Paediatric Orthopaedic Services.
In 1996, 91% of non children’s hospitals could perform elective surgery on children under 1 compared to 60% in 1996. The average minimum age for elective surgery in District General Hospitals increased from 8.5 months in 1996 to 17 months in 2001.
Baseline services are needed at each DGH to support the paediatric units. These services should include gait abnormalities, conservative treatment of CTEV, postural problems, straight forward cerebral palsy, assessment of hip instability and Perthes disease. Paediatric physiotherapists and Community Paediatricians may be involved in this aspect of care as part of the Multidisciplinary team. A hub and spoke regional service may be required where paediatric orthopaedic specialists undertake outreach clinics in District General Hospitals in order to assess more complex problems such as resistant CTEV, DDH and complex Cerebral Palsy. Such a system already exists in other specialities such as paediatric neurology. Clinical networks may improve service standards.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
