PurposeThe aim of this study was to elucidate developmental dysplasia of the hip (DDH) diagnosis and treatment preferences among members of the Pediatric Orthopaedic Society of North America (POSNA) and European Paediatric Orthopaedic Society (EPOS).MethodsA 54-question survey on DDH diagnosis and treatment preferences was distributed to POSNA and EPOS members. Descriptive statistics were performed.ResultsA total of 459 responses were analyzed. Ultrasound was the preferred modality for diagnosing DDH in infants less than six months old; few surgeons preferred radiographs. In all, 57% of POSNA members had radiology technicians perform ultrasounds, only 7% of EPOS members did. The percent coverage defining a dislocated hip varied greatly, the most frequent response being < 20% for POSNA and < 40% for EPOS members. Pavlik harnesses were the most popular harness/brace, used by 90% of POSNA and 71% of EPOS members. POSNA members were more likely than EPOS members to use a rigid abduction brace following initial harness/brace failure. For residual acetabular dysplasia, POSNA members were twice as likely as EPOS members to institute hip abduction bracing. Most surgeons would not perform closed reduction at less than three months of age or open reduction at less than six months of age. Most EPOS ­members used traction prior to reduction; few POSNA members did. Few POSNA and EPOS members believed that reduction should be delayed until the ossific nucleus was visible.ConclusionThere is great variation in the preferred methods for diagnosing and treating DDH. This survey is the largest transcontinental survey to compile diagnostic and treatment preferences for DDH. With wide variations in practice, there is room for quality improvement.Level of Evidence II

Intraoperative O-arm images accurately detect significant pedicle screw violations in the thoracic and lumbosacral spine but are less accurate for the cervical spine.

The extensor mechanism of the knee-consisting of the four muscles of the quadriceps, the quadriceps tendon, the patella, and the patellar ligament-is essential for lower extremity function during both standing and ambulation. The presence of articular cartilage and growing physes in the pediatric knee, coupled with the generation of significant tensile force, creates an opportunity for pathology unique to the pediatric population.Tibial tubercle fractures and patella injuries are quite rare, and even pediatric-trained orthopaedic surgeons may not be exposed to these injuries on a regular basis. It is the intent of this article to discuss the current literature regarding the mechanism of injury, diagnostic workup, classification, indications for surgical versus non-surgical management, and techniques for operative management for both tibial tubercle and patella (transverse and sleeve) fractures.