A century of pediatric orthopedics and traumatology: A journey of growth and transformation

INTRODUCTION

The story of pediatric orthopedics and traumatology over the last 100 years reads less as a sequence of technical facts and more like a reflection on how the medical world responded to the needs, growth, and resilience of childhood. It reflects how epidemics, wars, and scientific revolutions influenced the discipline, and the persistent efforts of physicians who refused to accept deformity or functional disability as a child’s destiny.

HISTORICAL FOUNDATIONS

At the dawn of the 20^th century, the challenges were immense. Infectious diseases such as poliomyelitis and tuberculosis filled hospital wards with children whose lives would be permanently marked by motor paralysis and multiple complex deformities. Surgeons of that era, working with limited tools and even more limited understanding, with only devises, braces, splints, and surgical procedures that were often as ingenious as they were heroic. The contributions of pioneers such as Hugh Owen Thomas, with his splinting philosophy, and Sir Robert Jones, who institutionalized orthopedic practice and education, laid the groundwork for the pediatric orthopedics discipline, endowing it with a sense of purpose and identity.^[1,2]

Those early decades revealed something crucial: children were not simply small adults. Their bones grew, remodeled, and healed quite differently. Their deformities told stories not just of pathology, but of growth interrupted or redirected. This realization became the intellectual cornerstone of pediatric orthopedics.

ADVANCES ACROSS A CENTURY

The mid-20^th century brought with it new allies. Antibiotics, safer anesthesia, and radiography transformed surgery from a perilous gamble into a more calculated and precise intervention. Standardized classifications and long-term follow-up studies enabled conditions such as developmental dysplasia of the hip (DDH) and scoliosis to be tracked, analyzed, and treated with greater consistency.^[3,4]

Few advances symbolize this spirit better than the Ignacio Ponseti method for clubfoot. Developed through meticulous clinical observation, it offered a gentle, thoughtful alternative to extensive surgeries, proving that careful study of natural physiology could yield solutions more elegant than forceful maneuvers.^[5] In this way, the field began to see itself not only as a surgical discipline but as a science of growth and adaptation.

The same philosophy lies at the heart of guided growth, popularized by Peter Steven, who has reshaped how we address angular deformities and limb length discrepancies. Rather than relying on large corrective osteotomies, surgeons learned to harness the biology of the physis — the growth plate itself — to gradually realign bones during a child’s natural development. The evolution of guided growth, from early epiphysiodesis^[6] to staples and later to contemporary tension-band plates, reflects a profound shift: instead of imposing correction from outside, orthopedics now partners with growth itself to achieve balance.^[7]

In the last two decades, Latin America, the Middle East, and the Asia Pacific territories have played a distinctive role in adopting and adapting all these innovations. Advances such as ultrasound-based screening for DDH, combined with early treatment with Pavlik’s harness,^[8] have improved outcomes and reduced long-term sequelae. A paradigm shift has occurred in abandoning unnecessary orthoses for benign conditions such as idiopathic genu varum, genu valgum, and flatfoot, recognizing that they resolve naturally without the need for intervention. External fixation has provided efficient solutions for congenital deformities, limb lengthening, pseudoarthrosis in neurofibromatosis, and severe musculoskeletal trauma.^[9,10] The Ponseti method — now firmly established as the gold standard treatment— has revolutionized the prognosis for children with clubfoot worldwide, offering near-universal correction and eliminating the burden of just structural and disabling surgeries.^[6] The global dissemination of this method is emblematic: a technique born in Iowa, now taught and applied in clinics worldwide, transforming lives in settings far removed from its birthplace. Guided growth, likewise, has spread swiftly across all continents, reflecting the effectiveness of minimally invasive approaches when surgical expertise and patient needs yield magnificent results.

FUTURE DIRECTIONS AND ONGOING CHALLENGES

Despite this progress, pediatric orthopedics in developing countries continues to face structural barriers. National health budgets frequently prioritize neonatal and adult mortality over children’s musculoskeletal health. Preventive programs remain underdeveloped: from early detection of skeletal deformities to the prevention of road traffic injuries, substance abuse, and non-accidental trauma, all of which may leave lasting marks not only on the developing skeleton but on their psyche as well.

Future progress will require not only the promise of regenerative medicine, biologically informed implants, and artificial intelligence-assisted diagnostics, but also renewed investment in prevention, integration with pediatric and primary care, and education tailored to each country’s socio-economic realities. Global international courses, such as the AO Pediatric Course and many others, harness the power of international collaboration by bringing together global experts with young surgeons in practical, hands-on learning that responds directly to community needs.^[11] The digital platforms expanded during the COVID-19 pandemic, and after, made running online courses and transferring knowledge globally easier and more cost-effective.

CONCLUSION

If history teaches us anything, it is that progress in pediatric orthopedics is rarely linear. It is iterative, often born from trial and error, always demanding humility before the complexities of the growing child. The century behind us is a reminder of how far we have come; the century ahead is an invitation to remain as curious, compassionate, and collaborative as those who built this specialty before us — while ensuring that no child, anywhere, is left behind.