Deep Dive in DDH is a three part limited series where experts in the field of DDH have been invited to discuss the controversies in the management of hip dysplasia. Episode 1 discusses the management of DDH in infants under 6 months of age from stable sonographic dysplasia through refractory developmental hip dislocation. We are joined by Kishore Mulpuri from BC Children's hospital, Simon Kelley from Texas Children's Hospital, and Wudbhav Sankar from Children's hospital of Philadelphia as we discuss areas of consensus and discord in Pavlik harness treatment, second line therapy, and what to do when problems arise. Hosted by Will Morris (Scottish Rite for Children). Edited by Carter Clement (Manning Family Children's Hospital). Music by A. A. Aalto. Referenced Publications

• Behman AL, Bradley CS, Maddock CL, Sharma S, Kelley SP. Testing of an Ultrasound-Limited Imaging Protocol for Pavlik harness Supervision (TULIPPS) in developmental dysplasia of the hip: a randomized controlled trial. Bone Joint J. 2022 Sep;104-B(9):1081-1088. doi: 10.1302/0301-620X.104B9.BJJ-2022-0350.R2. PMID: 36047018.
• Gans I, Flynn JM, Sankar WN. Abduction bracing for residual acetabular dysplasia in infantile DDH. J Pediatr Orthop. 2013 Oct-Nov;33(7):714-8. doi: 10.1097/BPO.0b013e31829d5704. PMID: 23812157.
• Swarup I, Talwar D, Sankar WN. Part-time Abduction Bracing in Infants With Residual Acetabular Dysplasia: Does Compliance Monitoring Support a Dose-dependent Relationship? J Pediatr Orthop. 2021 Feb 1;41(2):e125-e129. doi: 10.1097/BPO.0000000000001704. PMID: 33165268.
• Striano B, Schaeffer EK, Matheney TH, Upasani VV, Price CT, Mulpuri K, Sankar WN; International Hip Dysplasia Institute. Ultrasound Characteristics of Clinically Dislocated But Reducible Hips With DDH. J Pediatr Orthop. 2019 Oct;39(9):453-457. doi: 10.1097/BPO.0000000000001048. PMID: 31503230.
• Harper P, Joseph BM, Clarke NMP, Herrera-Soto J, Sankar WN, Schaeffer EK, Mulpuri K, Aarvold A; International Hip Dysplasia Institute (IHDI). Even Experts Can Be Fooled: Reliability of Clinical Examination for Diagnosing Hip Dislocations in Newborns. J Pediatr Orthop. 2020 Sep;40(8):408-412. doi: 10.1097/BPO.0000000000001602. PMID: 32555048; PMCID: PMC7458090.
• Murnaghan ML, Browne RH, Sucato DJ, Birch J. Femoral nerve palsy in Pavlik harness treatment for developmental dysplasia of the hip. J Bone Joint Surg Am. 2011 Mar 2;93(5):493-9. doi: 10.2106/JBJS.J.01210. PMID: 21368082.

Dr. Reid Nichols from Nemours joins the show to discuss her recent article on Ponseti treatment of arthrogrypotic clubfeet. The discussion spans numerous foot pathologies including bunions, coalitions, flatfeet, and some stuff you've probably never heard of! The gang is also excited to welcome a new host, Steph Logterman, to the podcast!

Your hosts are Carter Clement (Manning Family Children’s in New Orleans), Tyler McDonald (University of South Alabama), Craig Louer (Vanderbilt), and Steph Logterman (Arnold Palmer Hospital for Children). Music by A. A. Aalto.

References:

The 10-Year Functional Outcome of Ponseti Treatment of Idiopathic and Arthrogrypotic Clubfeet With an Age-Matched Control. Church et al. JPO 2025.

Surgical Treatment for Painful Pediatric Pes Planovalgus: How Does Subtalar Extra-articular Screw Arthroereisis Compare to the Standard Technique of Modified Evans Reconstruction? Nasreddine et al. JPO 2025.

Bedside Aspiration for Workup of the Pediatric Septic Hip: Avoid Trips to the OR and Expedited Time to Diagnosis. K Skaggs et al. JPO 2025.

Timing Matters: Challenges in Delayed Surgical Management of Pediatric Humeral Medial Epicondyle Fractures. Lee et al. JPO 2025.

Part 2 of a 2-part series recapping the 2025 POSNA Annual Meeting in Las Vegas. In this episode, we sit down with the 2025 Program Committee — Drs. Julie Samora, Tony Riccio, John Vorhies, and Christine Ho — to hear what’s new and what makes this year’s meeting stand out. Drs. Lindsay Andras, Apurva Shah, Firoz Miyanji, and Christine Ho highlight some standout presentations from the Awards Papers session. Drs. Stu Weinstein and John Birch share their thoughts on memorable Case Reports and how this new format adds a unique dimension to the meeting. We also chat with Dr. Jon Schoenecker, winner of the Best Basic Science Paper, and Dr. Dan Sucato, winner of the Best Clinical Paper, to learn more about their award-winning research. Hosted by Tyler McDonald (University of South Alabama) and Will Morris (Scottish Rite for Children). Music by A. A. Aalto.

Part 1 of a 2-part series recapping the 2025 POSNA Annual Meeting in Las Vegas. In this episode, we’re joined by Drs. Julia Sanders and David Spence (Trauma Session), Drs. Amy McIntosh and Lorena Flocarri (Spine Session), Drs. Ray Liu and Sean Tabaie (Neuromuscular and Lower Extremity Session), and Drs. Eduardo Novais and Eric Fornari (Hip Session) to discuss highlights from their respective sessions. Hosted by Tyler McDonald (University of South Alabama) and Will Morris (Scottish Rite for Children). Music by A. A. Aalto.

April 2025 Show Notes

Drs. Jill Larson and Vineeta Swaroop from Northwestern University and Lurie Children’s Hospital in Chicago join the podcast for a journal club-style discussion of their group’s studies concerned with care for children with Spina Bifida and Neuromuscular Conditions. The lightening round articles touch on determination of femoral anteversion in the operating room, regional anesthesia for hip surgeries, and the value of tapping for pedicle screws during spine deformity surgery.

Your hosts are Craig Louer (Vanderbilt University), Carter Clement (Manning Family Children's Hospital in New Orleans), Tyler McDonald (University of South Alabama), and Will Morris (Scottish Rite for Children).

Main Event – Spina Bifida Journal Club

1. Dias LS, Swaroop VT, de Angeli LRA, Larson JE, Rojas AM, Karakostas T. Myelomeningocele: a new functional classification. J Child Orthop. 2021;15(1):1-5. doi:10.1302/1863-2548.15.200248

1. May JM, DeMaio EL, Larson JE. Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity. J Pediatr Orthop. 2025;45(2):87-92. doi:10.1097/BPO.0000000000002848

1. Poggiali P, May JM, Larson JE, Dias LS. Talectomy for the Treatment of Rigid Nonidiopathic Clubfoot Deformity: Long-term Follow-up. Journal of the Pediatric Orthopaedic Society of North America, Volume 9, 100112

1. Arkin C, Ihnow S, Dias L, Swaroop VT. Midterm Results of the Ponseti Method for Treatment of Clubfoot in Patients With Spina Bifida. J Pediatr Orthop. 2018;38(10):e588-e592. doi:10.1097/BPO.0000000000001248

1. Thompson RM, Foley J, Dias L, Swaroop VT. Hip Status and Long-term Functional Outcomes in Spina Bifida. J Pediatr Orthop. 2019;39(3):e168-e172. doi:10.1097/BPO.0000000000001266

Lightning Round

1. Yao B, Li D, Cui J, et al. Establishment of an Accurate and Precise Alternative Intraoperative Technique for Determination of Femoral Version. J Pediatr Orthop. Published online March 21, 2025. doi:10.1097/BPO.0000000000002920’

1. Reysner M, Reysner T, Janusz P, et al. Pericapsular Nerve Group (PENG) Block Versus Lumbar Erector Spinae Plane Block (ESPB) in Pediatric Hip Surgery: A Randomized, Double-Blinded, Controlled Trial. J Pediatr Orthop. 2025;45(4):e324-e330. doi:10.1097/BPO.0000000000002882

1. Tate A, Brouillet K, Braithwaite Iv HC, Luhmann SJ. Pedicle Screw Placement in Pediatric and Adolescent Spinal Deformity Surgery: Does Tapping of the Pedicle Screw Tract Increase Safety?. J Pediatr Orthop. 2025;45(5):269-273. doi:10.1097/BPO.0000000000002909

Dr. Jeff Martus from Vanderbilt University joins the podcast to discuss his recent article on comparative outcomes between plating and intramedullary nails for the treatment of forearm fractures in children and adolescents. The theme for the episode is trauma and touches on management of a variety of fractures including lateral condyles, supracondylar humerus fractures, pelvic and acetabular trauma, and even the pitfalls of mutton bustin’.

Your hosts are Will Morris (Scottish Rite for Children). Tyler McDonald (University of South Alabama), Craig Louer (Vanderbilt), and Julia Sanders (University of Colorado). Music by A. A. Alto.

References:

1. Forearm Fractures in Older Children and Adolescents: ORIF is Safer Than IMN With Equivalent Outcomes. JPO. 2025 Mar. PMID: 39445700
2. Practice Patterns Vary Widely in the Care of Pediatric and Adolescent Pelvic and Acetabular Fractures: A CORTICES Survey. JPO. 2025 Mar. PMID: 39428588.
3. Pediatric Lateral Condyle Fractures with Elbow Dislocation: Revisiting the Song Classification of the Most Severe Injuries. JPO. 2025 Mar. PMID: 3990788.
4. Percutaneous Screw Fixation for the Management of Delayed Unions in Pediatric Lateral Humeral Condylar Fractures. JPO. 2025 Mar. PMID: 39523729.
5. Presentation to the Emergency Department Increases the Likelihood of Surgical Management of Minimally Displaced Gartland Type IIa Pediatric Supracondylar Humerus Fractures. JPO.2025 Mar. PMID: 39327894.
6. Remodeling of Sagittal Plane Malunion After Pediatric Supracondylar Humerus Fractures. JPO. 2020 Nov/Dec. PMID: 32604347.
7. From Sheep to Sling: Pediatric Injuries Due to Rodeo Mutton Bustin’. JPO. 2025 Apr. PMID: 39831656.

Dr. Aaron Huser from Washington University in St. Louis joins us to discuss his recent article on the 2-year outcomes of a surgical technique for treating knee flexion contracture in patients with arthrogryposis. This episode also includes a surprise drop-in from Dr. Perry Schoenecker.

We also highlight recent studies on arthrogryposis, radiolucent lesions in children with osteogenesis imperfecta, and rod deformation after cutting.

Your hosts are Tyler McDonald (University of South Alabama), Craig Louer (Vanderbilt), Carter Clement (Manning Family Children's Hospital in New Orleans), and Will Morris (Texas Scottish Rite in Dallas).

Music by A. A. Aalto.

References:

1) Increasing the Knee Arc of Motion in Patients With Arthrogryposis: Minimum 2-year Follow-up. Huser et al. JPO. 2025 Feb. PMID: 39466235.

2) Analysis of Scoliosis Rod Deformation After Cutting with a Surgical Rod Cutter. Egan et al. Spine Deformity. 2025 Jan. PMID: 39881049.

3) Do Not Forget the Spine MRI in Children with Arthrogryposis Multiplex Congenita: High Prevalence of Tethered Spinal Cord and Preliminary Clinical Findings Following Detethering. Nugraha et al. JPO. 2025 Feb. PMID: 39380182.

4) Evaluation of Radiolucent Lesions in Cortices of Long Bones in Osteogenesis Imperfecta Patients. Cook et al. JPOSNA. 2024 Oct.

5) Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity. May et al. JPO. 2025 Feb. PMID: 39501684.

Florian Dobler and Nathalie Alexander from the Laboratory for Gait Analysis in St. Gallen, Switzerland, join the show to discuss their recent research on the impact of obesity on femur development. The conversation spans several of their gait-related studies on lower extremity rotation and the effects of femoral and tibial osteotomies. Your hosts are Carter Clement from Children's Hospital of New Orleans and Tyler McDonald from University of South Alabama. Music by A. A. Aalto.

References:

1) Body Mass Index is Related to Femoral Anteversion, Hip Rotation During Gait, and Passive Hip Range of Motion in Children and Adolescents. Dobler et al. JPO, Oct 2024. PMID: 39482988.

2) Effect of femoral derotational osteotomy in patients with idiopathic increased femoral anteversion on joint loading and muscular demands. Alexander et al. JCO, Aug 2024. PMID: 39391579.

3) Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy. Alexander et al. Gait & Posture, 2020. PMID: 31981934.

4) Does pathologically increased or decreased tibial torsion affect muscle activations during walking in typically developing adolescents? Alexander et al. Journal of Biomechanics, 2021. PMID: 34509912.