Changes this year to the Specialty Update on Trauma reflect a clinical trend emerging in the field of orthopaedic traumatology toward greater specialization in certain areas. Examples of crystallizing expertise around certain clinical domains include geriatric and pediatric fracture management. Of course, such has already occurred with regard to anatomic trauma expertise in areas such as the upper extremity, the foot and ankle, the pelvis, and the spine. Accordingly, new sections have been added this year on fragility fractures and fracture treatment in the elderly.