Pediatric orthopaedics and rehabilitation.

Pediatric orthopaedic surgeons commonly interact with PM&R specialists as part of the rehabilitation team. This invited communication is intended to present the residency and fellowship education requirements for a pediatric orthopaedic surgeon and give a review of current work-force issues. Pediatric orthopaedic and PM&R collaboration may be in an acute setting, e.g., post injury or post surgery but more commonly occurs with management of chronic conditions, e.g., CP, myelodysplasia and other neuromuscular disorders. In the non-acute setting, even the pediatric orthopaedic surgeon must shift mental gears from a common “acute cure” mode, e.g., post idiopathic spinal deformity reconstruction or fracture treatment, to the less common “management” mode of a long term disease which necessitates a change of treatment pace, expectations, and continuity of care. Despite this change, the goal remains the same – maximization of remaining function. In the US, a pediatric orthopaedic surgeon first completes a highly competitive 5 year orthopaedic residency program in one of 152 accredited programs with ∼ 2850 residents. Post medical school graduation, first year rotations include critical care, burn management, surgery, trauma, neurosurgery, pediatric surgery and emergency medicine. The remaining 4 years are spent on clinical rotations involving acute care and elective reconstruction with increasing responsibility. Rotations of varying length are assigned in trauma, joint arthroplasty, sports orthopaedics, pediatric orthopaedics, adult spine, hand/upper extremity, foot/ankle, and orthopaedic oncology. Didactic train-