Department of Orthopedic Surgery: Non-operative Pediatric Fellowship

What is non-operative pediatric orthopaedics?
What is the need for a non-operative pediatric orthopaedic fellowship?
History of the fellowship
Faculty
The University of Wisconsin Department of Orthopedics and Rehabilitation
The University of Wisconsin Children 's Hospital and the Department of Pediatrics
Fellowship Responsibilities
Application Guidelines

The University of Wisconsin is proud to offer the first and only fellowship in non-operative pediatric orthpaedics. This one-year fellowship is a joint venture on the part of the Department of Orthopaedics and Rehabilitation and the Department of Pediatrics to develop pediatricians trained in the care of children with musculoskeletal issues who desire to work as part of a pediatric orthpaedic group, primarily in the academic setting.

What is non-operative pediatric orthopaedics?

Pediatric orthpaedics encompasses the range of musculoskeletal issues from birth to adulthood. This includes congenital/neonatal disorders, such as developmental hip dysplasia, clubfoot, torticollis, metatarsus adductus, and limb deficiencies. Developmentally, pediatric orthopaedists evaluate children with gait abnormalities, including intoeing, outtoeing and toe-walking, leg length discrepancy, genu varum (Blount disease) and valgum, cerebral palsy, and neuromuscular disorders. Acute disease management includes the evaluation of the child with a limp or swollen joint, slipped capital femoral epiphysis, fractures, osteomyelitis, septic arthritis, and tumors. Sports medicine is a small component of pediatric orthopaedics that encompasses its own specialty.

The majority of these issues presenting in children do not require surgery and may be appropriately managed by a primary care physician with sufficient training in musculoskeletal medicine and the principles of orthopaedics. Most pediatric residency programs dedicate little or no time to the education of their residents in pediatric orthopaedics providing ample referrals to pediatric orthopaedists.

The fellow will receive training sufficient to manage the non-operative components of the aforementioned diseases, as well as many others. Procedural training will include the Ponseti management of clubfoot, joint aspiration and injection and fracture reduction/splinting/casting.

What is the need for a non-operative pediatric orthopaedic fellowship?

A recent survey of pediatric orthopaedic surgeons in the United States has revealed that the average age of the pediatric orthopaedists is 52. Thirteen fewer fellowship trained pediatric orthpaedic surgeons are produced annually than are needed to meet the workforce deficit generated by those retiring. The surgical demands placed on the remaining surgeons requires more than full-time attention. The remaining clinical demands add an additional workload that could be partially supplanted by non-surgical partners. This model already exists in the field of sports medicine, where primary care physicians work as partners with surgical specialists in the non-operative management of sports- and recreational-related injuries in older children and adults.

History of the fellowship

The University of Wisconsin Non-operative Pediatric Orthopaedics Fellowship was initiated in 2004 by Dr. Kenneth Noonan, funded by the Department of Orthopaedics and Rehabilitation and the Department of Pediatrics. Due to the success of the initial venture, funding to develop a formal fellowship was sought and secured through an unrestricted educational grant from EBI with additional support from the Department of Orthopaedics and Rehabilitation.

The fellowship lasts one-year, beginning July 1 and ending June 30. Employment opportunities will be actively sought by the fellowship directors to assist the fellow in securing a faculty appointment with an academic institution or partnership in a pediatric orthopaedic group.

Faculty

• Co-Director: Kenneth Noonan, MD
• Co-Director: Blaise Nemeth, MD, MS
• Pediatric Orthopaedics: David Mann, MD
• Sports Medicine: David Bernhardt, MD
• Sports Medicine: Greg Landry, MD
• Spine Medicine: James Leonard, DO, PT

The University of Wisconsin Department of Orthopedics and Rehabilitation

The Department includes surgical specialists in the fields of spinal surgery, sports medicine, hand surgery, foot and ankle surgery, joint replacement, oncological orthopaedics, orthopaedic trauma, in addition to pediatric orthopaedics. Additionally, the Department includes faculty in the specialty of adult and pediatric rehabilitation, primary care sports medicine and post-doctoral research specialists. There are five residents per year, 25 total, in addition to one surgical fellow in sports medicine and one in spine.

Currently, children with pediatric orthpaedic issues are evaluated and treated either in the orthopaedics clinic at the University of Wisconsin Hospital, the Spine Clinic at Research Park , the Middleton Rehabilitation clinic or the Waisman Center.

The University of Wisconsin Children's Hospital and the Department of Pediatrics

The Children's Hospital is a 60-bed unit within the University of Wisconsin Hospital. As a tertiary care center, referrals are drawn from southern, central and northeastern Wisconsin , northern Illinois , the Upper Penninsula of Michigan and northeastern Iowa . The hospital also cares for children with medical illnesses common in the community setting. The American Family Children's Hospital (web link) is currently under construction and will be the future home of the Department of Pediatrics. Plans include the construction of a dedicated pediatric orthopaedics clinic with radiologic, casting, and orthotics capabilities.

The Department includes specialists in all areas of pediatrics, as well as a large group of primary care pediatricians with both academic and community affiliations and all pediatric surgical subspecialties. There are thirteen residents per year and one chief resident. Fellowships include sports medicine, endocrinology, pulmonology and allergy, intensive care, and hematology/oncology.

Fellowship Responsibilities

Education

The fellow will gain knowledge in pediatric orthopaedics through patient care, faculty education, conference attendance, and directed self-education. The fellow will also attend a conference on the management of clubfoot (the Ponseti Technique – University of Iowa, the International Pediatric Orthopaedic Symposium and the annual meeting of the Pediatric Orthopaedic Society of North America.

Clinical care

The fellow will participate in patient care in the outpatient setting. Clinical responsibilities will consist primarily of those in pediatric orthopaedics, but will also include sports medicine, spine medicine, and rehabilitation. Additionally, the fellow will gain experience in fracture reduction in the emergency room and orthopaedic urgent care clinic.

Teaching

The fellow will be responsible for presenting on pediatric orthopaedic issues to the orthopaedic residents on a bi-monthly basis. Quarterly, one of these topics will be adapted and presented to the pediatric residents. The fellow will be required to present one Grand Rounds to the Department of Orthopaedics and Rehabilitation. The fellow will also participate in medical student education in the musculoskeletal examination as part of the Patient, Doctor and Society course (PDS 3). Other medical school and community educational opportunities are available and left to the discretion of the participating fellow.

Research

Each fellow will be required to participate in a research project during the one-year fellowship. A number of projects are underway at any given time and available as opportunities. Additionally, new projects may be developed tailored to the incoming fellow's interests and expertise. The fellowship directors will assist in protocol development and Human Subjects Committee (weblink) approval prior to the incoming fellow's start date. The fellow will be expected to participate in either the protocol development and HSC approval of their own project or one for the following year's fellow. The fellow's research will be presented at the Department of Orthopaedics Research Day and submission for publication will be expected.

Benefits

Salary and benefits will be the same as those offered at the PGY-4 level for all post-graduate trainees at the University of Wisconsin Hospital. Salary for the 2004-2005 academic year was $46,911. Benefits include health insurance, disability insurance, liability insurance. Additional catastrophic, dental, disability and life insurance are available at group rates.

Leave

Each fellow is afforded three weeks of vacation. The fellow will also be provided registration, transportation, room and board for the three required educational conferences (Ponseti, IPOS and POSNA).

Application (click here to download PDF version of application)

The application includes the application form itself, curriculum vitae, three letters of recommendation (one from the applicant's residency director, one from an orthopedist/sports medicine specialist, and one other letter) and a one-page personal statement. Additional questions may be directed to either:

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Administration - University of Wisconsin Department of Orthopedics & Rehabilitation
First published: 07/15/02 Last updated: 07/04/08 webmaster@surgery.wisc.edu
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