Section on Orthopaedics
Letter from the Chair

R M Schwend MD
Richard M. Schwend, MD
rmschwend@cmh.edu


The AAP Section on Orthopaedics (SOOr) was established in 1976 with the vision of our founding members including Bill
Schmidt MD, Leibe Diamond MD, Paul Griffin MD, Dennis Lyne MD, Paul Miller MD and Arthur Pappas MD. We are now
entering our 38th year as a Section.

The mission of the SOOr is to improve the care of infants, children, and adolescents by providing educational forums for the
discussion of problems and treatments related to orthopaedics in children.

The AAP Orthopaedic Section had a great year in 2013. Here are some of the year's highlights.
Education and Research
The American Academy of Pediatrics (AAP) SOOr Academic and Scientific Program was held in Orlando, Florida on Saturday, October 26, and on Sunday, October 27, during the Academy's National Conference & Exhibit. The Section promotes student, resident, and fellows-in-training research by encouraging them to present their work during the weekend meeting and having their faculty mentor in attendance to participate in the discussion of their work. Norman Otsuka as Section Abstract Chair with Eric Gordon as Section Program Chair ran an excellent meeting. Moderators for the sessions included Brian Smith, Lee Segal, David Feldman, Joshua Abzug, and Ted Ganley – SOOr members as well as Pediatric Orthopaedic Society of North America (POSNA). Jack Flynn gave the annual POSNA presidential address titled "The Changing Face of Pediatric Orthopaedics: Clinical, Socio-economic and Demographic Forces Rocking our Word." This was an insightful retrospective and prospective from Jack's mid-career vantage. A lively, no rules debate between Todd Lawrence and Bill Hennrikus on surgical stabilization for first time shoulder dislocations in adolescent athletes was a first, and a similar format is being designed for future years. Over 50 abstracts were presented during the day-and-a-half long meeting. It was also a record year for submissions with over 100 in consideration!

Bob Cady has generously funded through POSNA the Section's AAP Young Investigator Awards. In 2013 the awards went to Rachel Borlack (Albert Einstein College of Medicine) for "Adolescent Idiopathic Scoliosis Patients are at Increased Risk for Pulmonary Hypertension;" Ali Ashrof (Mayo) for "Acute Complications of Pediatric and Adolescent Knee Arthroscopy;"  Emily Stuart (Phoenix Children's Hospital) for "Musculoskeletal Medicine: An Assessment of Knowledge of Pediatric Residents and Faculty;" and Aviva Dworkin (Albert Einstein College of Medicine) for "Critical Events before Spinal Cord Injury in a Porcine Compression Model." These papers are automatically accepted as paper posters for the POSNA Annual Meeting in Hollywood, California, and the abstracts have been published in the Journal of Pediatric Orthopaedics, March 2014 issue.

The Section established the Distinguished Service Award (DSA) in1995 to recognize an individual in the field of pediatric orthopaedics who has contributed to the AAP's mission of excellence in patient care, research and teaching. The Section's Executive Committee selected Dr Walter Greene as the esteemed recipient of this honor for 2013. Dr. Greene has been an active POSNA member since 1983 and is best known for his compassionate care of children with disabilities, his understated mentoring of students and residents, and his lifetime work and dedication to improving the lives of those who have been fortunate enough to have worked with him or cared for by him.  Dr Greene, who was accompanied by his wife, Debby, gave the DSA lecture on the history of the Newington Hospital.

Other highlights of the meeting included a combined session of the Surgical Advisory Panel on "Imaging Gently in Radiology."  Members of the Orthopaedic Section and POSNA presented a number of teaching sessions to the general pediatricians including a casting and splinting workshop with Kathryn Keeler; office treatment of common fractures with Bill Hennrikus; evaluating gait disorders with John Anderson and Martin Herman; and approaches to pediatric back pain with Howard Epps and Richard Schwend.

The next SOOr program will take place October 11-12, 2014, in San Diego, California. There will be a large combined session on Friday October 10, called Pediatrics for the 21st Century(Peds 21). This is a half-day pre-Conference session – before the 2014 NCE – for pediatricians and pediatric subspecialists on one particular topic. Peds21 sponsored by the SOOr, the Council on Sports Medicine and Fitness, and the Section on Rheumatology. Larry Wells will be representing SOOr. We anticipate as many as 1,000 attendees and Academy leaders. We hope that you and your pediatrician colleagues are able to join us for 1, 2, 3, Go! Sports in the World of Pediatrics - Playing It Safe and Making It Fun!

After success of the 2012 "Neurotoxicity of Anesthesia in Infants" and the 2013 "Imaging Gently," the Surgery Advisory Panel (SAP) has decided to make this session an annual part of the NCE.  This year the SAP session in San Diego will be on hemangiomas and vascular malformations. Future topics may include: Health Care Inequities in Children (for the 2014 NCE in Washington DC), chest wall deformities, bleeding disorders, perioperative management of the medically fragile child, disaster management, surgical issues in spina bifida, obesity, coordinated care of the pediatric trauma patient, surgical site infections, surgery in countries with limited resources.

Ted Ganley is the incoming program chair for the AAP Section on Orthopaedics. If you have ideas for a teaching presentation to pediatricians for this meeting, please contact Dr. Ganley at ganley@email.chop.edu.

AAP Practical Pediatrics Speakers
Speakers 2013: Kit Song, Donna Pacicca, Paul Stricker, Terry McCambridge, Bill Phillips, Matt Bueche, Andrew Gregory
Speakers 2014: Chris Koutures, Bill Phillips, Andrew Gregory, Susan Scherl, Paul Stricker, Brian Shaw, Donna Pacicca

Leadership
The AAP Section on Orthopaedics has an eight-person leadership team. Ellen Raney, who was the previous Program Chair completed her term on the Executive Committee with an outstanding record of elevating the Section Program to its highest level ever. Ted Ganley was elected to Section leadership as of October 2013. He will be bringing much needed expertise in pediatrician and resident education to the Academy.
• Richard Schwend: Section Chair; POSNA Board of Directors; Representative to POSNA's Children's Orthopedics in Underserved Regions and the AAP Section on International Child Health; Member of the SOOr International Mentored Scholarship Committee, AAP Practical Pediatrics Committee, and the AAP Committee on Membership.
• William Hennrikus: Immediate Past Section Chair; Member of the Academy's NCE Planning Group planning (replacing John Sarwark); Immediate Past Chair of the AAP Practical Pediatrics Planning Group; AAP Grand Rounds Representative; AAP Disaster Preparedness Advisory Council Representative; Representative on the Scoliosis Research Society (SRS)/POSNA Device Task Force.
• Norman Otsuka: Incoming Section Chair; Academy Liaison to the US Bone and Joint Initiative Board of Directors; Section Abstract Chair; SOOr Advocacy Leader (working with the DC Office); Treasurer and Fundraising Committee Member.
• Ted Ganley: Liaison to the Section on Medical Students, Residents, and Fellowship trainees; Liaison to the Council on Sports Medicine & Fitness; Incoming Section Program Chair; SOOr Media Representative; International Mentored Scholarship Committee Member.
• Eric Gordon: AAP Program Chair, Fundraising Committee Member, International Mentored Scholarship Committee Member.
• Brian Smith: Section Historian; SOOr Membership Chair; Liaison to SRS BrAIST Task Force.
• Brian Shaw: Publications and Policy Development Chair; Policy and Publications Chair; Assists with Pediatrics in Review; International Mentored Scholarship Committee Member.
• Lawrence Wells: Peds 21 Representative; Policy and Publications Assistant Chair
• Niccole Alexander, MPP: Manager, Division of Hospital & Surgical Services, oversees issues related to the hospitalization of children, pediatric hospitalists, orthopaedics/bone health, and transport medicine on behalf of the Academy.

Other Active Members:
• Peter Pizzutillo: Editorial Board Member of Pediatrics in Review
• Paul Esposito: former USBJI AAP Liaison
• Ellen Raney: former Executive Committee Member, develops curriculum for primary care.
• Yi-Meng Yen (Beng): Oversees new "train the trainers" program, assists with SOMSRFT activities related to the Section.
• Dave Spiegel: International Mentored Scholarship Committee member, PediaLink Program Developer
• Bob Cady: Young Investigator Awards
• Brian Snyder: Assists with advocacy efforts
• Josh Abzug: Handbook of Musculoskeletal Medicine, assists with the development of "train the trainer" concept.
• Marty Herman: Member of the Section Nominating Committee
• Josh Abzug: Member of the Section Nominating Committee

Executive Committee Election:
The following were elected to the Executive Committee:
• Norman Otzuka: to replace Richard Schwend as Section Chair
• Brian Shaw:; to serve another membership term
• Joshua Hyman: to replace Eric Gordon as member

New Programs
AAP International Scholarship. Thanks to a generous grant from K2M company, the AAP Section on Orthopaedics has developed a scholarship program for pediatric orthopaedic fellows and orthopaedic residents to join a pediatric orthopaedic surgeon to work in an under resourced country. These are typically 1-2 week trips. Up to $1,500 per person is available for travel and housing expenses.  The deadline for the application is November 1, 2014 for travel in 2015.  A selection committee with Richard Schwend (nonvoting member), Brian Shaw, Ted Ganley, Eric Gordon, Dave Spiegel, Linda Arnold (from the Section on International Child Health), and a member of Section on Medical Students, Residents, and Trainee Fellows review the applications. Materials can be found on the SOOr web site at http://www2.aap.org/sections/ortho. This program won the Innovation Award at the recent AAP Annual Leadership Forum in March 2014.

Publications and Policy Development, AAP Publications Review. Brian Shaw has taken on the task of reviewing all AAP publications that may affect the Section on Orthopaedics and pediatric orthopaedics in general. He has developed a list of Section members who have agreed to volunteer to review these publications, ranging from AAP book chapters to clinical practice guidelines. When SOOr is asked to review a manuscript, Brian may request that a Section member oversee the review. There is typically a one-month period to respond. During the October 2014 NCE meeting there is a plan to acknowledge all reviewers.

Workforce Survey. Jeffrey Sawyer, Chair of the POSNA Practice Management Committee, has worked with Rick Schwend and AAP staff to develop the AAP workforce survey. AAP and POSNA staff have worked hard to condense the instrument into a smaller package that meets the needs of both organizations. AAP staff is completing final questionnaire and plans to share the results with POSNA. AAP is slated to do the analysis. When the survey arrives in your inbox, we strongly encourage you to take the time to complete this survey.

Publications
Klein, Michael. Recommendations for Referral to Pediatric Surgical Specialists. Published online January 27, 2014, Pediatrics Vol. 133 No. 2 February 1, 2014; pp. 350 -356.
Flaherry E, Hennrikus W, Levine M, Perez-Rosello J. Evaluating children with fractures for abuse. Pediatrics 2014;133:477-489.
Labella C, Hennrikus W, Hewett T. ACL injuries in children. Pediatrics 2014:135;298-312.
AAP Grand Rounds 2013-2014 editorials/reviews by William Hennrikus:
• Treatment of stable paediatric forearm fractures using a cast that may be removed at home. Hamilton TW et al. J Bone Joint Journal 2013; 95B:1714-1720.
• Effects of bracing in adolescents with scoliosis. Weinstein SL et al. New England Journal of Med 2013:369;1512-1521.
• Glucocorticoid treatment for prevention of scoliosis in children with Duchenne Muscular Dystrophy. Lebel DE, et al. J Bone Joint Surg 2013, 95A:1057-1061.
• Risedronate in children with osteogenesis imperfect: a randomized, double blind, placebo controlled trial. Bishop N et al. Lancet 2013;13,1-9.
• Botulism A toxin does not improve the results of cast treatment for idiopathic toe walking. Engstrom P et al. J Bone Joint Surg 2013;95A:40-407.

In progress
• A clinical report on clubfoot is being drafted by Bob Cady and Theresa Hennessey.
• Josh Abzug is working on a clinical report documenting the state of musculoskeletal education to our pediatric residents and young pediatric physicians. This effort may start as a resolution to the Annual Leadership Forum with a proposal to survey AAP members, following the award winning survey done by Emily Stuart and Lee Segal, Musculoskeletal Medicine: An Assessment of Knowledge of Pediatric Residents and Faculty."
• Handbook of Pediatric Musculoskeletal Care. Josh Abzug is working on a proposal to produce a handbook on pediatric musculoskeletal care. The format would be simple one- to two-page paragraphs, case based, with illustrations and imbedded video. The first handbook would be targeted to the US audience and the second version to the international community.
• DDH statement. Brian Shaw and Lee Segal have drafted a clinical report on developmental dysplasia of the hip (DDH) screening and referral. The document is on hold pending the publication of American Academy of Orthopaedic Surgeons Clinical Practice Guideline on DDH.

Membership
Membership in the Section is open to all POSNA members, and we encourage ALL graduating pediatric orthopaedic fellows to apply. Please contact the Membership Chair, Brian Smith, with questions (brian.g.smith@yale.edu).

The AAP Section on Orthopaedics website has been updated. Please view at www2.aap.org/sections/ortho.

Thank you all for being active participants and engaged in the mission of the AAP Section on Orthopaedics. We look forward to seeing you in San Diego in October!!

Richard M. Schwend MD, FAAP

 
06/14