AO Surgery Reference-Pediatric Trauma: a unique educational tool

Fergal Monsell shares insights about the reference tool

13 March 2019

Fergal Monsell

Fergal Monsell, General Editor of AO Surgery Reference-Pediatric Trauma


Fergal Monsell, coauthor and editor of the AO Surgery Reference-Pediatric Trauma (AOSR-PT) talks about the origin of the resource, its importance, and its uniqueness in an interview conducted during the AO Foundation Davos Courses in December 2018.

The origin of the AO Surgery Reference-Pediatric Trauma (AOSR-PT)

Recognizing that there was a knowledge gap in pediatric fracture management, the AO supported the development of the AOSR-PT project. This was driven by longtime AOSR General Editor Chris Colton who had a major role in improving the profile of pediatrics within the AO business plan and encouraged the AO Strategy Fund to support this project. The relevance of a resource of this type was supported by a survey that demonstrated that a pediatric trauma reference was a necessity and not simply a good idea.

Fergal Monsell joined the project and has served either as author or editor in all modules published so far. The first two modules, distal radius and distal humerus, were launched two years ago together with a generic documentation, authored by Chris Colton and James Hunter, highlighting the essential principles of pediatric fracture care.

The uniqueness of the AOSR-PT

Monsell estimates that the majority of pediatric fractures are managed by non-specialist surgeons throughout the world. Currently available educational material including textbooks and podcasts lack detail about the technical aspects of surgical fixation and stabilization, decision making, and factors that are unique to children that must be understood by the treating surgeon. This is where the AOSR-PT fills an important gap, providing a valuable resource that allows surgeons to safely and effectively approach the management of pediatric fractures, regardless of their geographical location. The authors recognize that many users are not native English speakers and the language and style has been adapted to make the AOSR-PT accessible to all.

The AOSR-PT is relevant to a global audience and incorporates very low-tech, principle-based to very high-tech equipment-based fracture treatment. It provides a unique, multi-dimensional educational resource and is therefore useful to surgeons of all levels of experience, practicing in all kinds of environments, from hospitals in “Manhattan to Mogadishu”. Surgeons can choose the approach best suited to their individual circumstances and are provided with a clearly illustrated, step-by-step reference, including information on operating room setup, radiological diagnosis and aftercare. The AOSR-PT format is extensively researched, mirrors the AOSR for adults and is user friendly, easily accessible and of clear educational benefit attracting 10,000 users per month.

Content development challenges

Development of the AOSR-PT content is a very labor-intensive undertaking and production is limited to one annual module to ensure that the quality of the product is maintained. The main difficulty is providing a consensus view that is appropriate for a global audience with diverse resources and surgical experience, Monsell explained.

“Since what we do in medicine is not always scientific or evidence-based, but instead relies on experience or opinion, we have to find a consensus view that is appropriate for a global audience, understanding the diversity of resources and surgical experience.” he said. “The AOSR-PT tries to align all these factors to offer all surgeons what they need, no matter who or where they are. The task force is very open to feedback and adaptation of the modules based on discussion within the consensus group.”

Format and structure

The quality of the AOSR-PT relies on detailed discussion between editors and two to three authors prior to and during the production of each module. 
The order in which the anatomical area modules are created was determined by the task force on the basis of global need with a rating system of fractures by frequency and severity/importance. The factual content is checked and cross-checked at all stages by seven to nine people (artists, authors, editors, officers, etc).

What’s next?

Monsell said the AOSR-PT continues to grow.

“We have recently launched a module that provides a detailed description of management of fractures of the shaft of the radius and ulna including bowing and greenstick fractures, the Monteggia lesion and its equivalents,” he said. “This complements the previous modules that consider the distal radius and ulna, and the distal humerus.”

The proximal forearm module, complementing the forearm shaft, will be published in the first half of 2019 and modules of the femoral shaft and distal femur are already planned.

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